Key result
Despite therapeutic anticoagulation with heparin and later argatroban, a patient with HIT II and cardiogenic shock on ECMO developed solid and recurrent thrombotic masses in the left atrium and ventricle.
Case Report (n=1)
This case highlights the severe and recurrent nature of intracardiac thrombosis in patients with HIT II requiring mechanical circulatory support, even when treated with direct thrombin inhibitors like argatroban.
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Recurrent thrombosis despite argatroban in HIT II on ECMO warrants caution; leaves open optimal anticoagulation strategies.
The combination of heparin-induced thrombocytopenia (HIT) II, left ventricular failure with extracorporeal membrane oxygenation (ECMO) therapy, and recurrent left ventricular thrombosis is rare and predicts a poor outcome. In this case, HIT II occurred after an ischemic cardiogenic shock. We initiated ECMO and intra-aortic balloon pump therapy during coronary artery bypass grafting and ventricular thrombectomy. Despite continued therapeutic therapy with heparin and later argatroban, the patient developed solid and recurrent thrombotic masses in the left atrium and left ventricle.
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Wendt et al. (2013) conducted a case report in Heparin-induced thrombocytopenia (HIT) II, left ventricular failure, recurrent left ventricular thrombosis (n=1). ECMO, intra-aortic balloon pump, CABG, ventricular thrombectomy, heparin, and argatroban was evaluated on Recurrent thrombotic masses in the left atrium and left ventricle. Despite therapeutic anticoagulation with heparin and later argatroban, a patient with HIT II and cardiogenic shock on ECMO developed solid and recurrent thrombotic masses in the left atrium and ventricle.
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