Delayed-onset severe heparin-induced thrombocytopenia after total arch replacement under cardiopulmonary bypass

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  • Nakayama MD Taisuke
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Kinoshita MD Hajime
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Sugano MD Mikio
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Kurobe MD, PhD Hirotsugu
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Kanbara MD Tamotsu
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Fujimoto MD Eiki
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Kitaichi MD PhD Takashi
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School
  • Fujita MD Hiroshi
    Imabari Daiichi Hospital
  • Sogabe MD, PhD Hitoshi
    Imabari Daiichi Hospital
  • Kitagawa MD, PhD Tetsuya
    Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School

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Abstract

An extremely rare case with delayed-onset heparin-induced thrombocytopenia (HIT) is described. A 46-year-old man underwent arch replacement for aortic dissection under cardiopulmonary bypass and initial exposure of unfractionated heparin. In post operative 7 days, persistent atrial fibrillation was occurred, so a continuous infusion of heparin (10000 IU/day) and Vitamine K antagonist (Warfarin) taking was started for preventing thrombosis. By 32 days after the operation, his platelet count had fallen (3×103/µL) and oral hematoma and ecchymoma of bilateral lower legs were occurred. The value of HIT antibodies and the IgG antibody was 2.485 and 1.586 on 32-postoperative day, respectively. Heparin was immediately discontinued, and argatroban administrated. Platelet exceeded above 100×103/µL on 12 days of the therapy. To our knowledge, few cases of delayed-onset severe HIT associated with CPB surgery have been reported in Japan. J. Med. Invest. 60: 154-158, February, 2013

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