What question did this study set out to answer?

To describe a case of rapid-onset heparin-induced thrombocytopenia leading to acute coronary artery embolism and cardiogenic shock during transcatheter aortic valve replacement.

July 23, 2025CureusOpen Access

Rapid-Onset Heparin-Induced Thrombocytopenia Leading to Cardiogenic Shock Due to Left Anterior Descending Artery Embolism During Transcatheter Aortic Valve Replacement

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Rapid-onset heparin-induced thrombocytopenia during TAVR (n=1). Intervention: Unfractionated heparin.

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Key result

An 84-year-old woman developed fatal rapid-onset heparin-induced thrombocytopenia and cardiogenic shock due to coronary embolism shortly after heparin administration during TAVR.

Why the study?

Rapid-onset HIT carries high potential for rapid progression and fatal outcomes, requiring clinical suspicion in perioperative settings involving routine heparin use.

Population

One 84-year-old female undergoing TAVR with prior heparin exposure

Design

Case report

Follow-up

10 days

Authors

AKAtsuhiro KitauraCity University of New York YYYukari YoshinoNagoya University Hospital HSHiroatsu SakamotoKanagawa Dental University

Discussion

Member takes

Implication

Rapid-onset HIT after heparin re-exposure warrants vigilance in sensitized patients; this case report leaves open optimal prevention strategies.

Key Points

To describe a case of rapid-onset heparin-induced thrombocytopenia leading to acute coronary artery embolism and cardiogenic shock during transcatheter aortic valve replacement.
Documented the clinical progression and intraoperative rescue management of an 84-year-old female receiving unfractionated heparin during transcatheter aortic valve replacement (TAVR) two weeks after percutaneous coronary intervention.
Assessed diagnostic monitoring and interventions, including transesophageal echocardiography, 4Ts score calculation, emergent venoarterial extracorporeal membrane oxygenation (VA-ECMO), and anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA).
Intraoperative unfractionated heparin administration triggered an intracardiac thrombus within 10 minutes and left anterior descending coronary artery occlusion within 30 minutes, producing acute left ventricular dysfunction and cardiogenic shock.
Postoperative contrast-enhanced computed tomography confirmed multiorgan systemic embolization, including right middle cerebral artery and renal infarctions, resulting in patient death on postoperative day 10.
Laboratory testing confirmed a positive anti-PF4/heparin immunoassay alongside a final 4Ts score of 6, establishing the diagnosis of rapid-onset heparin-induced thrombocytopenia.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

An 84-year-old female with severe aortic stenosis and recent heparin exposure who underwent transcatheter aortic valve replacement and developed rapid-onset heparin-induced thrombocytopenia.

Exposure

Unfractionated heparin administration during TAVR.

Outcome

Development of rapid-onset heparin-induced thrombocytopenia (HIT) leading to cardiogenic shock, systemic embolization, and death.safety

This case highlights the critical need for a high index of suspicion for rapid-onset HIT in patients with recent heparin exposure who develop sudden intraoperative thromboembolic events and hemodynamic collapse during TAVR.

Limitations

Functional assays for HIT antibodies were not performed due to limited availability and poor patient prognosis.
Delayed diagnosis due to the difficulty of distinguishing HIT from other TAVR-related complications in the acute phase.
Functional assays for HIT antibodies were not performed due to limited availability in Japan.

Cite This Study

Kitaura et al. (2025) conducted a case report in Rapid-onset heparin-induced thrombocytopenia during TAVR (n=1). Unfractionated heparin was evaluated. An 84-year-old woman developed fatal rapid-onset heparin-induced thrombocytopenia and cardiogenic shock due to coronary embolism shortly after heparin administration during TAVR.

synapsesocial.com/papers/6a93ef20189c14fbc5b942c5 https://doi.org/10.7759/cureus.88622

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Implication

Rapid-onset HIT after heparin re-exposure warrants vigilance in sensitized patients; this case report leaves open optimal prevention strategies.

Rapid-Onset Heparin-Induced Thrombocytopenia Leading to Cardiogenic Shock Due to Left Anterior Descending Artery Embolism During Transcatheter Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Rapid-Onset Heparin-Induced Thrombocytopenia Leading to Cardiogenic Shock Due to Left Anterior Descending Artery Embolism During Transcatheter Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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