"Keep HIT in Mind and Take Care". Multiple Tips From a Single Patient.

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
International Medical Case Reports Journal Pub Date : 2025-02-18 eCollection Date: 2025-01-01 DOI:10.2147/IMCRJ.S500148
Sergio Bevilacqua, Pierluigi Stefàno, Viola Ranfagni, Bianca Ammannati, Riccardo Codecasa, Anna Maria Gori, Francesca Cesari, Lara Mary Titherington, Stefano Del Pace, Angela Rogolino, Rossella Marcucci
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引用次数: 0

Abstract

Introduction: Heparin-induced thrombocytopenia (HIT) is a relatively rare condition burdened by a high rate of complications and mortality. Cardiac surgery is a high risk setting for this condition. But in this area, some particularities can make both diagnosis and treatment difficult. Warfarin is often needed after valvular surgery but may be dangerous if HIT is ongoing. Danaparoid is the only anticoagulant whose mechanism of action has been demonstrated to counteract the pathogenesis of HIT. However, the 24-hour half-life challenges its use after surgery.

Case presentation: Here, we present a case in which HIT occurred six days after cardiac surgery. Warfarin was initiated two days after surgery but was stopped five days later, given the high risk of bleeding due to concomitant thrombocytopenia. HIT probability was initially underestimated, because a misleading diagnosis of endocarditis was made. When redo surgery was performed, no infectious masses were found, but a large thrombus was removed from the left atrium. Bivalirudin and danaparoid were used as alternative anticoagulants during the subsequent postoperative course.

Conclusion: HIT should always be kept in mind after cardiac surgery, even if a more plausible cause of thrombocytopenia is present. Discontinuation of warfarin could lead to catastrophic consequences if an unrecognized HIT is ongoing, and an alternative anticoagulant is not started. Bivalirudin and danaparoid were used after the diagnosis of HIT, adapting anticoagulant therapy to the needs of recent surgery.

“记住HIT,小心”。一个病人的多重提示。
肝素诱导的血小板减少症(HIT)是一种相对罕见的疾病,其并发症和死亡率都很高。心脏手术是这种情况的高风险设置。但在这个领域,一些特殊性会给诊断和治疗带来困难。瓣膜手术后通常需要华法林,但如果HIT持续,则可能有危险。丹那帕肽是唯一的抗凝血剂,其作用机制已被证明可以对抗HIT的发病机制。然而,24小时的半衰期对手术后的使用提出了挑战。病例介绍:在这里,我们报告了一例心脏手术后6天发生HIT的病例。手术后2天开始使用华法林,但考虑到伴随的血小板减少导致出血的高风险,5天后停用华法林。由于心内膜炎的错误诊断,HIT的概率最初被低估了。重做手术时,没有发现感染性肿块,但从左心房取出了一个大血栓。在随后的术后过程中,比伐鲁定和达那那肽被用作替代抗凝剂。结论:心脏手术后应始终牢记HIT,即使存在更合理的血小板减少的原因。停用华法林可能会导致灾难性的后果,如果一个未被识别的HIT正在进行,替代抗凝剂没有开始。诊断为HIT后使用比伐鲁定和达那那肽,使抗凝治疗适应近期手术的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Medical Case Reports Journal
International Medical Case Reports Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
135
审稿时长
16 weeks
期刊介绍: International Medical Case Reports Journal is an international, peer-reviewed, open access, online journal publishing original case reports from all medical specialties. Submissions should not normally exceed 3,000 words or 4 published pages including figures, diagrams and references. As of 1st April 2019, the International Medical Case Reports Journal will no longer consider meta-analyses for publication.
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