A Case of Heparin-Induced Thrombocytopenia (HIT) following Aortic Surgery for Acute Type A Aortic Dissection

(Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Funabashi, Japan)

Masayoshi Katsumata Yoshiharu Takahara Kenji Mogi
Atsushi Tamura
A 44-year-old man underwent total arch replacement for acute type A aortic dissection. He was treated postoperatively in the intensive care unit for acute renal failure and respiratory failure. Although recovery of organ functions was seen, an unexpected fall in platelet count (PLT) occurred abruptly on postoperative day (POD) 7. The patient was treated with gabexate mesilate and platelet transfusion because disseminated intravascular coagulation (DIC) was initially suspected. Nevertheless, PLT dropped rapidly below 1.0~104/l. We suspected heparin-induced thrombocytopenia (HIT) and stopped all heparin administration including flush solution for pressure monitoring lines. The platelet factor 4-reactive HIT antibody test was performed and we began to give intravenous argatroban, 60mg/day. However, PLT did not increase at all. Multiple organ failure developed and metabolic acidosis deteriorated rapidly resulting in death on POD15. HIT antibody was positive on POD13 and a definitive diagnosed of HIT was made. For those patients treated with heparin continuously or repeatedly, HIT may occur and increase the mortality risk if the diagnosis is delayed.
@Jpn. J. Cardiovasc. Surg. 35: 222-225 (2006)