Early valve thrombosis after transcatheter aortic valve implantation associated with difficulty in initiating antiplatelet therapy and heparin-induced thrombocytopenia: a case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Clinical valve thrombosis after transcatheter aortic valve implantation complicated by heparin-induced thrombocytopenia (n=1). Intervention: Argatroban. Primary outcome: Transcatheter aortic valve flow velocity.

Shoko Kitaguchi; Keita Inoue; Kunihiko Kooguchi; Kazuki Hosono; Jun Hatabe; Teppei Tsuneishi; Makoto Watanabe; Miho Inoue

doi:10.3918/jsicm.33_r36

January 1, 2026Journal of the Japanese Society of Intensive Care MedicineOpen Access

Early valve thrombosis after transcatheter aortic valve implantation associated with difficulty in initiating antiplatelet therapy and heparin-induced thrombocytopenia: a case report

View Full Paper

Ask AI

Bookmark

Share

Key result

Argatroban reduces transcatheter aortic valve flow velocity by ~0.9 m/s in HIT-complicated valve thrombosis.

n=1

Key Points

To describe a case of early clinical valve thrombosis after transcatheter aortic valve implantation in a patient with heparin-induced thrombocytopenia and delayed antiplatelet initiation.
A female in her 70s with end-stage renal failure on maintenance hemodialysis underwent transcatheter aortic valve implantation (Sapien3 Ultra RESILIA 23 mm) complicated by ventricular perforation requiring open surgical repair.
Antiplatelet therapy was withheld due to bleeding risks from a persistent pericardial hematoma, and anticoagulation was monitored alongside repeated clinical evaluations, 4T's scoring, and imaging.
Evaluation included transthoracic echocardiography, contrast-enhanced computed tomography, and replacement of heparin with argatroban after heparin-induced thrombocytopenia was confirmed.
The patient developed heparin-induced thrombocytopenia confirmed on day 18 by a 4T's score of 7 and a positive antibody titer of 6.7 U/mL (increased from 0.6 U/mL on day 3), alongside multi-vessel clotting and cerebral infarctions.
Echocardiography revealed transcatheter aortic valve peak velocity of 4.4 m/s, and computed tomography on day 22 demonstrated hypoattenuated leaflet thickening consistent with valve thrombosis, as well as superior mesenteric artery thrombosis.
Following conversion of anticoagulation to argatroban (titrated from 2.5 μg/kg/min to 0.1 μg/kg/min), transvalvular peak velocity decreased to 4.05 m/s on day 2 and 3.49 m/s on day 3.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A female patient in her 70s who developed early clinical valve thrombosis after transcatheter aortic valve implantation due to difficulty in initiating antiplatelet therapy and concurrent heparin-induced thrombocytopenia.

I

Intervention

Argatroban (initial 2.5 μg/kg/min, adjusted to 0.1 μg/kg/min) for clinical valve thrombosis

Implication

Clinical valve thrombosis can occur early after TAVI when antiplatelet therapy is withheld and HIT develops, requiring alternative anticoagulation such as argatroban.

Abstract

No abstract yet. The journal hasn't published one we can show.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kitaguchi et al. (2026) conducted a case report in Clinical valve thrombosis after transcatheter aortic valve implantation complicated by heparin-induced thrombocytopenia (n=1). Argatroban was evaluated on Transcatheter aortic valve flow velocity. Administration of argatroban for clinical valve thrombosis complicated by heparin-induced thrombocytopenia reduced transcatheter aortic valve flow velocity from 4.4 m/s to 3.49 m/s.

synapsesocial.com/papers/6ad2358c0ff4ed60a31526a2 https://doi.org/10.3918/jsicm.33_r36

View Full Paper

Ask AI

Bookmark

Share

Early valve thrombosis after transcatheter aortic valve implantation associated with difficulty in initiating antiplatelet therapy and heparin-induced thrombocytopenia: a case report

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Early valve thrombosis after transcatheter aortic valve implantation associated with difficulty in initiating antiplatelet therapy and heparin-induced thrombocytopenia: a case report

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Keep reading

More from Journal of the Japanese Society of Intensive Care Medicine

Keep reading

More from Journal of the Japanese Society of Intensive Care Medicine