Near fatal stent thrombosis in an aneurysmatic RCX as first manifestation of heparin induced thrombocytopenia (HIT) without thrombocytopenia.
Aneurysm, Ruptured
/ diagnostic imaging
Anticoagulants
/ administration & dosage
Aortic Aneurysm, Thoracic
/ diagnostic imaging
Autoantibodies
/ blood
Blood Vessel Prosthesis Implantation
Coronary Aneurysm
/ complications
Coronary Stenosis
/ diagnostic imaging
Coronary Thrombosis
/ diagnostic imaging
Drug-Eluting Stents
Heparin
/ administration & dosage
Humans
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Platelet Factor 4
/ immunology
Risk Factors
Thrombectomy
Thrombocytopenia
/ blood
Treatment Outcome
Case report
Coronary aneurysm
HIT
Heparin-induced thrombocytopenia
White thrombus
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
31 12 2021
31 12 2021
Historique:
received:
21
06
2021
accepted:
21
12
2021
entrez:
1
1
2022
pubmed:
2
1
2022
medline:
1
2
2022
Statut:
epublish
Résumé
Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention. A supposedly "completely healthy" 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis. The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.
Sections du résumé
BACKGROUND
Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention.
CASE PRESENTATION
A supposedly "completely healthy" 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis.
CONCLUSIONS
The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.
Identifiants
pubmed: 34972517
doi: 10.1186/s12872-021-02442-3
pii: 10.1186/s12872-021-02442-3
pmc: PMC8720211
doi:
Substances chimiques
Anticoagulants
0
Autoantibodies
0
PF4 protein, human
0
Platelet Factor 4
37270-94-3
Heparin
9005-49-6
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
624Informations de copyright
© 2021. The Author(s).
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