Kumar Aman, Ankush Ankush, Sharma Jitender
Department of Radiodiagnosis, All India Institute of Medical Sciences Bhopal, Bhopal, India.
Department of Radiodiagnosis, LN Medical College & JK Hospital, Bhopal, India.
Vasc Specialist Int. 2024 Sep 30;40:35. doi: 10.5758/vsi.240065.
We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May-Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May-Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May-Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.
我们报告了一例罕见的肝素诱导的血小板减少症伴血栓形成（HITT）病例，该病例发生在治疗合并深静脉血栓形成（DVT）的May-Thurner综合征后，导致静脉支架血栓形成。一名27岁的急性左下肢DVT男性患者成功接受了May-Thurner综合征的溶栓和支架置入治疗。然而，患者在术后3天出现复发性血栓形成和血小板减少症。抗血小板因子4-肝素抗体检测呈阳性，确诊为HITT。停用肝素后，患者成功接受磺达肝癸钠治疗，随后再次进行血栓切除术和溶栓治疗，然后过渡到华法林治疗。这是May-Thurner综合征中第二例因HITT导致静脉支架血栓形成的报告病例。该病例强调了早期识别和及时使用磺达肝癸钠等替代抗凝剂治疗HITT以预防诸如静脉肢体坏疽等并发症的重要性。需要进一步的随机对照试验来评估磺达肝癸钠在HITT中的安全性和有效性。
