American Society of Hirudotherapy

Delayed-onset heparin-induced thrombocytopenia

Case series published in Ann Emerg Med (2005)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportDrug DevelopmentClinical LiteratureSmythe MA et al. · Annals of emergency medicine, 2005

Abstract

Delayed-onset heparin-induced thrombocytopenia is a syndrome in which thrombocytopenia and thrombosis begin several days after heparin discontinuation. Delayed-onset heparin-induced thrombocytopenia is caused by immunoglobulin G antibodies that are reactive against the heparin-platelet factor 4 complex in the absence of circulating heparin. We describe 2 patients with delayed-onset heparin-induced thrombocytopenia who presented to the emergency department. An 88-year-old man and a 62-year-old man experienced thrombocytopenia and thrombosis 9 or more days after heparin cessation and demonstrated a further decrease in platelet count on reexposure to heparin. Delayed-onset heparin-induced thrombocytopenia should be included in the differential diagnosis of a patient with recent heparin exposure who presents with thrombosis or thrombocytopenia.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal Article
Indexed MeSH termsAgedAged, 80 and overAnticoagulantsEmergency Service, HospitalHeparinHirudinsHumansMaleMiddle AgedPlatelet Factor 4Recombinant ProteinsThrombocytopeniaTime FactorsVenous Thrombosis

Summary

Two men aged 62 and 88 developed thrombocytopenia and thrombosis 9 or more days after heparin cessation, with further platelet drops on heparin reexposure, prompting recommendations to include delayed-onset HIT in the differential diagnosis.

Context

This article presents two cases of delayed-onset heparin-induced thrombocytopenia, describing an 88-year-old man and a 62-year-old man who developed thrombocytopenia and thrombosis nine or more days after heparin cessation, with further platelet decline on reexposure. The abstract explains the syndrome as mediated by IgG antibodies reactive against the heparin–platelet factor 4 complex even in the absence of circulating heparin, and emphasizes the importance of including delayed-onset HIT in differential diagnosis. The abstract itself does not mention hirudin, lepirudin, leeches, or any anticoagulant therapy. The scope is diagnostic recognition based on two case reports, with no treatment detail.

Citation

Reference (Vancouver style)

Smythe MA, Stephens JL, Mattson JC. Delayed-onset heparin-induced thrombocytopenia. Ann Emerg Med. 2005;45(4):417-419. doi:10.1016/j.annemergmed.2004.08.005. PMID: 15795722

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

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