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A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is characterized by low platelets and thrombosis after exposure to Heparin products. It is classically characterized by a rapid and significant drop in platelets and life-threatening thrombosis. Thrombosis can occur up to 50% of the cases if left untreated. It...

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Autores principales: Deen, Imad U., Jha, Swati A., Mustafa, Sadaf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Greater Baltimore Medical Center 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529653/
https://www.ncbi.nlm.nih.gov/pubmed/36262487
http://dx.doi.org/10.55729/2000-9666.1102
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author Deen, Imad U.
Jha, Swati A.
Mustafa, Sadaf
author_facet Deen, Imad U.
Jha, Swati A.
Mustafa, Sadaf
author_sort Deen, Imad U.
collection PubMed
description Heparin-induced thrombocytopenia (HIT) is characterized by low platelets and thrombosis after exposure to Heparin products. It is classically characterized by a rapid and significant drop in platelets and life-threatening thrombosis. Thrombosis can occur up to 50% of the cases if left untreated. It requires immediate discontinuation of all heparin products and switching to a non-heparin anticoagulant to prevent further thrombosis. Here we present a case of a 56-year-old male who presented to the Emergency Department with sudden onset of severe left leg pain. Duplex study showed arterial thrombosis in the common iliac and distal iliac arteries. He received TPA at once and underwent thrombectomy while his platelet continued to drop. He used Low Molecular Weight Heparin (enoxaparin) for bridging after his tonsil surgery a week prior to this hospital admission. His HIT assay was found to be positive and despite the Argatroban therapy his clinical condition continued to worsen while his platelet count continued to drop. Given the refractory nature of the thrombosis and thrombocytopenia; Intravenous immunoglobulin (IVIG) therapy was introduced. The patient showed a great response and his platelet count improved to 150,000/μ. He was discharged on warfarin with a closer follow-up. Few case reports have described the treatment of such refractory cases using intravenous immunoglobulin (IVIG), resulting in stabilized platelet counts, reduced platelet activation, and reduced thrombotic complications, the exact mechanism of which is unknown. It is thought that IVIG inhibits platelet activation by binding as platelet receptors, which would otherwise bind with heparin–platelet factor 4 complexes and HIT antibodies.
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spelling pubmed-95296532022-10-18 A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia Deen, Imad U. Jha, Swati A. Mustafa, Sadaf J Community Hosp Intern Med Perspect Case Report Heparin-induced thrombocytopenia (HIT) is characterized by low platelets and thrombosis after exposure to Heparin products. It is classically characterized by a rapid and significant drop in platelets and life-threatening thrombosis. Thrombosis can occur up to 50% of the cases if left untreated. It requires immediate discontinuation of all heparin products and switching to a non-heparin anticoagulant to prevent further thrombosis. Here we present a case of a 56-year-old male who presented to the Emergency Department with sudden onset of severe left leg pain. Duplex study showed arterial thrombosis in the common iliac and distal iliac arteries. He received TPA at once and underwent thrombectomy while his platelet continued to drop. He used Low Molecular Weight Heparin (enoxaparin) for bridging after his tonsil surgery a week prior to this hospital admission. His HIT assay was found to be positive and despite the Argatroban therapy his clinical condition continued to worsen while his platelet count continued to drop. Given the refractory nature of the thrombosis and thrombocytopenia; Intravenous immunoglobulin (IVIG) therapy was introduced. The patient showed a great response and his platelet count improved to 150,000/μ. He was discharged on warfarin with a closer follow-up. Few case reports have described the treatment of such refractory cases using intravenous immunoglobulin (IVIG), resulting in stabilized platelet counts, reduced platelet activation, and reduced thrombotic complications, the exact mechanism of which is unknown. It is thought that IVIG inhibits platelet activation by binding as platelet receptors, which would otherwise bind with heparin–platelet factor 4 complexes and HIT antibodies. Greater Baltimore Medical Center 2022-09-09 /pmc/articles/PMC9529653/ /pubmed/36262487 http://dx.doi.org/10.55729/2000-9666.1102 Text en © 2022 Greater Baltimore Medical Center https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ).
spellingShingle Case Report
Deen, Imad U.
Jha, Swati A.
Mustafa, Sadaf
A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title_full A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title_fullStr A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title_full_unstemmed A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title_short A Case Report and Literature Review on Argatroban Refractory Heparin-Induced Thrombocytopenia
title_sort case report and literature review on argatroban refractory heparin-induced thrombocytopenia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529653/
https://www.ncbi.nlm.nih.gov/pubmed/36262487
http://dx.doi.org/10.55729/2000-9666.1102
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