Bioprosthetic valve thrombosis after transcatheter aortic valve replacement and pulmonary embolism due to heparin-induced thrombocytopenia: a case report.
TAVR—transcatheter aortic valve replacement
argatroban
bioprosthetic valve dysfunction
heparin-induced thrombocytopenia
intensive unit care
pulmonary embolism
thrombosis—etiology
Journal
Frontiers in cardiovascular medicine
ISSN: 2297-055X
Titre abrégé: Front Cardiovasc Med
Pays: Switzerland
ID NLM: 101653388
Informations de publication
Date de publication:
2023
2023
Historique:
received:
12
02
2023
accepted:
18
07
2023
medline:
24
8
2023
pubmed:
24
8
2023
entrez:
24
8
2023
Statut:
epublish
Résumé
Bioprosthetic valve thrombosis is a complication of transcatheter aortic valve replacement (TAVR). It is believed to be platelet independent, mainly driven by contact phase activation, and more likely to be targeted by oral anticoagulant (OAC). We report case of an 86-year-old man with history of TAVR, who presented an early TAVR aortic valve thrombosis occurring in the context of heparin-induced thrombocytopenia (HIT) and pulmonary embolism. The patient rapidly recovered and was discharged 17 days after readmission. OAC by Coumadin was administered for 3 months. Chest tomography after 3 months showed the disappearance of the hypoattenuated leaflet thickening. Although HIT has been fully described and is known for being a prothrombotic disorder, this is the first case report of aortic valve thrombosis after TAVR due to HIT. HIT is rare but possibly lethal. Diagnosis is based on pre-test probability evaluation with the 4T clinical score and confirmation with laboratory evidence of anti-PF4/heparin complexes and positivity of a functional test. Management of HIT is based on heparin discontinuation, and treatment of thrombotic complication with direct anti-IIa inhibitor or anti-Xa inhibitor. According to our knowledge, this case represents the first report of bioprosthetic valve thrombosis after TAVR due to HIT.
Sections du résumé
Background
UNASSIGNED
Bioprosthetic valve thrombosis is a complication of transcatheter aortic valve replacement (TAVR). It is believed to be platelet independent, mainly driven by contact phase activation, and more likely to be targeted by oral anticoagulant (OAC).
Case summary
UNASSIGNED
We report case of an 86-year-old man with history of TAVR, who presented an early TAVR aortic valve thrombosis occurring in the context of heparin-induced thrombocytopenia (HIT) and pulmonary embolism. The patient rapidly recovered and was discharged 17 days after readmission. OAC by Coumadin was administered for 3 months. Chest tomography after 3 months showed the disappearance of the hypoattenuated leaflet thickening.
Discussion
UNASSIGNED
Although HIT has been fully described and is known for being a prothrombotic disorder, this is the first case report of aortic valve thrombosis after TAVR due to HIT. HIT is rare but possibly lethal. Diagnosis is based on pre-test probability evaluation with the 4T clinical score and confirmation with laboratory evidence of anti-PF4/heparin complexes and positivity of a functional test. Management of HIT is based on heparin discontinuation, and treatment of thrombotic complication with direct anti-IIa inhibitor or anti-Xa inhibitor. According to our knowledge, this case represents the first report of bioprosthetic valve thrombosis after TAVR due to HIT.
Identifiants
pubmed: 37614940
doi: 10.3389/fcvm.2023.1164432
pmc: PMC10442482
doi:
Types de publication
Case Reports
Langues
eng
Pagination
1164432Informations de copyright
© 2023 Faucher, Marchandot, Carmona, Ohana, Trimaille and Morel.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Am J Cardiol. 2017 Jul 15;120(2):300-303
pubmed: 28576265
JACC Cardiovasc Interv. 2019 Jan 14;12(1):12-18
pubmed: 30621972
J Thorac Cardiovasc Surg. 2012 Jul;144(1):108-11
pubmed: 21864857
Eur Heart J Cardiovasc Imaging. 2018 Apr 1;19(4):398-404
pubmed: 28950318
J Clin Med. 2019 Apr 12;8(4):
pubmed: 31013785
J Cardiothorac Vasc Anesth. 2015 Dec;29(6):1603-5
pubmed: 25604599
Ann Thorac Surg. 2021 Jul;112(1):32-37
pubmed: 33217393