A Case of Heparin-Induced Thrombocytopenia (HIT) following Aortic Surgery for Acute Type A Aortic Dissection
10.4326/jjcvs.35.222
- VernacularTitle:急性Ａ型大動脈解離手術後に発症したヘパリン起因性血小板減少症（ＨＩＴ）の１例
- Author:
Masayoshi Katsumata
;
Yoshiharu Takahara
;
Kenji Mogi
;
Atsushi Tamura
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2006;35(4):222-225
- CountryJapan
- Language:Japanese
-
Abstract:
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/μl. 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 POD 15. HIT antibody was positive on POD 13 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.
