American Society of Hirudotherapy

Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment

Case reports published in Blood Coagul Fibrinolysis (2004)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportDrug DevelopmentClinical TrialsPaparella D et al. · Blood coagulation & fibrinolysis, 2004

Abstract

Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAdultAgedAmputation, SurgicalAortic DissectionAnticoagulantsAortaAortic AneurysmAortic ValveBlood Vessel Prosthesis ImplantationCombined Modality TherapyCoronary Artery BypassEarly Diagnosis

Summary

Two HITT cases post-cardiac surgery occurring earlier than typical (<5 days); rapid diagnosis and lepirudin infusion saved limb in 1, IABP delayed recognition led to amputation in the other.

Why This Matters for Hirudotherapy

This case report describes two cases of heparin-induced thrombocytopenia with thrombosis (HITT) occurring early (within five days of heparin exposure) after open heart surgery, both treated with the direct thrombin inhibitor lepirudin. In the first case, prompt diagnosis enabled early lepirudin administration following heparin discontinuation; in the second, delayed recognition due to an intra-aortic balloon pump meant lepirudin infusion could not prevent limb amputation. While lepirudin is described as a direct thrombin inhibitor used in treatment, the abstract does not mention its origin, leeches, or hirudotherapy. No defensible leech link can be drawn from the abstract alone; this is a two-case clinical report focused on diagnostic timeliness in post-cardiac surgery HITT.

Citation

Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment.

Paparella D et al. · Blood coagulation & fibrinolysis, 2004

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

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