Key result
Patent foramen ovale closure with unfractionated heparin administration was complicated by massive device thrombosis, multiple embolisms, and delayed-onset heparin-induced thrombocytopenia at 3 weeks.
Case Report (n=1)
Highlights a rare but severe complication of delayed-onset heparin-induced thrombocytopenia leading to massive device thrombosis and multiple embolisms following PFO closure.
Highlights potential thrombotic complications after PFO closure; hypothesis-generating and leaves true incidence open.
A 40-year-old man was referred to our centre for a patent foramen ovale (PFO) closure 8 months after a cryptogenic stroke. A Cardioform Septal Occluder device (GSO; W.L. Gore and Associates) was successfully positioned with transoesophageal echocardiography (TEE) guidance. A 100 UI/kg bolus of unfractionated heparin was administered during the procedure. Three weeks later, the patient presented with sudden right lower limb pain, pallor, and pulselessness of the distal arteries. Whole-body contrasted-enhanced computed tomography (CT) showed a right popliteal artery thrombus (Panel A) but also a segmental pulmonary embolism, a silent intraluminal left carotid artery thrombosis, and a massive thrombus of both sides of the PFO prosthesis (Panel B), which was confirmed by TEE (Panel C). Blood analyses showed elevated D-dimer at 10.32 ng/L and platelets at 36 × 109/L suggesting a delayed-onset heparin-induced thrombocytopenia. Treatment with a direct thrombin inhibitor (Argatroban)...
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Blanc-Vannet et al. (2022) conducted a case report in Patent foramen ovale (n=1). Patent foramen ovale closure and unfractionated heparin was evaluated. Patent foramen ovale closure with unfractionated heparin administration was complicated by massive device thrombosis, multiple embolisms, and delayed-onset heparin-induced thrombocytopenia at 3 weeks.
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