Wound Necrosis and Peripheral Microangiopathy due to Delayed-onset Heparin-induced Thrombocytopenia Following Arterial Bypass Surgery

Delayed-onset heparin-induced thrombocytopenia (HIT) is a rare side effect of heparin. This prothrombotic condition can present its first signs up to three weeks following heparin administration even if heparin use has been stopped. A 54-year-old claudicant patient underwent a suprageniculate limb bypass with heparin administration. Despite bypass patency, our patient developed recurrent wound necrosis and kept complaining of ischemic pain. The patient then developed toe necrosis and underwent leg amputation. Delayed-onset HIT is a rare condition that should be looked for and promptly managed in patients with peripheral vasculopathy following heparin administration.