Key result
HIT can cause near-fatal acute stent thrombosis even in the absence of actual thrombocytopenia.
Why the study?
Thrombosis from heparin-induced thrombocytopenia occurs in about 2% of patients without a significant decrease in platelet counts, prompting the report of a near-fatal thrombotic event caused by coronary intervention.
Case Report (n=1)
No
Acute stent thrombosis immediately after coronary intervention should raise suspicion for heparin-induced thrombocytopenia (HIT) even if platelet counts are normal.
Alerts clinicians to atypical HIT in unexplained stent thrombosis; extends case reports but leaves open need for validation.
BACKGROUND: Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention. CASE PRESENTATION: A supposedly "completely healthy" 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis. CONCLUSIONS: The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.
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Zoller et al. (2021) conducted a case report in Heparin-induced thrombocytopenia (HIT) without thrombocytopenia (n=1). Unfractionated heparin was evaluated on Development of acute stent thrombosis and HIT. Heparin-induced thrombocytopenia can manifest as near-fatal acute stent thrombosis even in the absence of thrombocytopenia, requiring immediate recognition and alternative antithrombotic therapy.
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