A fatal complication in a patient with heparin-induced thrombocytopenia type II re-exposed to heparin

The heparin-induced thrombocytopenia type II is a rare but important drug related complication associated with thrombocytopenia and thrombosis. We report on a patient with elective revision of the total hip arthroplasty. Preoperatively for nineteen days, the patient received unfractionated heparin 5...

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Main Authors: Hoffmann, Ursula (Author) , Huhle, Günter (Author) , Rossol-Haseroth, Karin (Author) , Heene, Dieter L. (Author) , Harenberg, Job (Author)
Format: Article (Journal)
Language:English
Published: 01 September 1999
In: European journal of orthopaedic surgery & traumatology
Year: 1999, Volume: 9, Issue: 3, Pages: 205-207
ISSN:1432-1068
DOI:10.1007/BF00542596
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/BF00542596
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Author Notes:U. Hoffmann, G. Huhle, K. Haseroth, D.L. Heene, J. Harenberg

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520 |a The heparin-induced thrombocytopenia type II is a rare but important drug related complication associated with thrombocytopenia and thrombosis. We report on a patient with elective revision of the total hip arthroplasty. Preoperatively for nineteen days, the patient received unfractionated heparin 5000 IU three times daily for thromboprophylaxis. Postoperatively the patient developed a platelet drop from 236000/μl to 69000/μl an iliac vein thrombosis and pulmonary embolism. In assumption of heparin induced thrombocytopenia anticoagulation was switched to danaparoid-sodium subcutaneously. Platelet count rised to normal values while three days. Because of a negative heparin-induced platelet aggregation assay, anticoagulation was switched to a PTT controlled high dose intravenous unfractionated heparin. Two days after re-exposition to heparin platelet counts dropped to 34000/μl blood. The patient died 12 days after readministration of heparin due to respiratory and circulatory failure. Postmortem analysis of serum revealed positive heparin/platelet factor 4 IgG-antibodies. 
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