Parashar Jaytesh, Shivnani Ganesh, Dubey Sumir, Bisht Bhupender Singh, Saifi Nadeem
Department of Adult Cardiac Surgery, Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, India.
Dept of Adult Cardiac Surgery, Sir Gangaram Hospital, New Delhi, India.
Indian J Thorac Cardiovasc Surg. 2025 Apr;41(4):486-489. doi: 10.1007/s12055-024-01839-x. Epub 2024 Oct 19.
We report a case of hyperacute multiple graft thrombosis following an uneventful coronary artery bypass graft (CABG) surgery in a 69-year-old female with chronic immune thrombocytopenia (ITP). Detailed evaluation revealed the presence of anti-PF4/heparin antibodies, confirming the diagnosis of heparin-induced thrombocytopenia (HIT). The co-existence of chronic ITP masked the thrombocytopenia typically associated with HIT, complicating the recognition of the thrombotic and hematologic abnormalities. This case emphasizes the importance of promptly discontinuing heparin when HIT is suspected or confirmed. Additionally, maintaining a low threshold for suspecting HIT in patients with ITP undergoing cardiac surgery is crucial, as this complex interplay may increase the risk of severe postoperative complications.
我们报告了一例69岁患有慢性免疫性血小板减少症（ITP）的女性患者，在冠状动脉旁路移植术（CABG）手术过程顺利后发生超急性多支移植血管血栓形成的病例。详细评估发现存在抗PF4/肝素抗体，确诊为肝素诱导的血小板减少症（HIT）。慢性ITP的并存掩盖了通常与HIT相关的血小板减少症，使血栓形成和血液学异常的识别变得复杂。该病例强调了在怀疑或确诊HIT时及时停用肝素的重要性。此外，对于接受心脏手术的ITP患者，保持对HIT的低怀疑阈值至关重要，因为这种复杂的相互作用可能会增加术后严重并发症的风险。
