Anticoagulation with a selective thrombin inhibitor in a woman with heparin-induced thrombocytopenia.

Abstract

Heparin-induced thrombocytopenia is an immunologic complication of heparin therapy with potentially serious venous and arterial thrombotic sequelae. Progression to overt thrombosis is the most serious complication, occurring in approximately 0.5% of heparin-treated patients. Previous strategies for treatment of the associated thrombosis with heparin-induced thrombocytopenia have frustrated clinicians with poor outcomes. A 45-year-old woman with stage IB endometrial cancer underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. She suffered a pulmonary embolism postoperatively. The pulmonary embolism was treated with heparin, and heparin-induced thrombocytopenia and central vein catheter-related thrombosis developed. She underwent thrombectomy and was successfully anticoagulated with a selective thrombin inhibitor instead of heparin. This treatment should be considered for patients with heparin-induced thrombocytopenia in either a prophylactic or a treatment regimen.