Heparin‐induced Thrombocytopenia With Associated Disseminated Intravascular Coagulation

Haemorrhagic and thrombotic complications (Rhodes et al, 1 9 7 7) as well as disseminated intravascular coagulation (DIC) (Bell & Royall, 1980) have all been described during the course of heparin-induced thrombocytopenia. We report a patient with heparin-induced thrombocytopenia associated with an unusually prolonged but self-limited episode of DIC. Mr S.J. was a 60-year-old man who presented for insertion of an epicardial pacemaker. On admission the platelet count, haemoglobin, red cell morphology, clotting profile, thrombin time and prothrombin ratio were all normal. Prophylactic calcium heparin (5000 u b.d.; porcine intestinal mucosa) was given subcutaneously in the peri-operative period, but post-operatively he developed a left popliteal artery embolus, a deep venous thrombosis (DVT) of the right calf and multiple pulmonary emboli. Intravenous heparin therapy was commenced, but further pulmonary emboli occurred. A second platelet count, 3 weeks after Hnerna t d o g y Depn rt men t ,