Heparin-induced thrombocytopenia requiring VA-ECMO management during percutaneous coronary intervention for acute coronary syndrome: A case report
Research article published in Journal of cardiology cases (2024)
Abstract
UNLABELLED: Heparin-induced thrombocytopenia (HIT) is an immune-mediated disease with severe thromboembolic complications. HIT during percutaneous coronary intervention (PCI) can be fatal without prompt treatment. We report an unusual case of HIT observed during PCI for acute coronary syndrome (ACS). A 74-year-old female with a history of pulmonary embolism managed with unfractionated heparin (UFH) 2 years previously presented with intermittent chest pain. Coronary angiography revealed total occlusion of the mid-right coronary artery. Before and during the primary PCI, 14000 UFH units were administered. However, abundant thrombus formation in the non-culprit lesion was refractory to repeated thrombus aspiration. We suspected HIT, discontinued UFH, and administered argatroban. Despite repeated thrombus aspirations and balloon dilatation, coronary obstruction persisted; consequently, ventricular fibrillation refractory to multiple cardioversions occurred. Therefore, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was required. Platelet counts rapidly decreased to <50 % of the baseline value, and serum was highly positive for IgG-specific antiplatelet factor 4/heparin antibodies. The patient was discharged with independent gait and no major neurological disorders. This is a clinically noteworthy case of rapidly developing HIT during primary PCI for ACS, requiring VA-ECMO management, with no major neurological complications. HIT may occur immediately after re-exposure to heparin long after the first exposure. LEARNING OBJECTIVE: Without prompt treatment, heparin-induced thrombocytopenia (HIT) during percutaneous coronary intervention (PCI) can be fatal. It may lead to refractory coronary obstruction, which may need to be managed by veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We present a clinically noteworthy case of rapidly developing HIT during primary PCI for acute coronary syndrome, requiring VA-ECMO management, with no major neurological complications. Physicians must be mindful that HIT may occur immediately after re-exposure to heparin long after the first exposure.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to anticoagulation, leech therapy, and microsurgical flap management. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This case report documents a 74-year-old woman with prior heparin exposure who developed heparin-induced thrombocytopenia (HIT) during primary PCI for acute coronary syndrome, with refractory thrombus formation, platelet counts dropping to under 50% of baseline, strongly positive IgG anti-PF4/heparin antibodies, ventricular fibrillation, and the need for VA-ECMO; unfractionated heparin was stopped and the direct thrombin inhibitor argatroban was substituted, with the patient ultimately discharged neurologically intact. It is directly relevant to the leech-therapy and anticoagulation narrative because HIT is the central clinical reason heparin alternatives — including direct thrombin inhibitors mechanistically related to leech-derived hirudin — exist, and it shows such agents being deployed when heparin must be abandoned. The caveat is that this is a single descriptive case: it illustrates recognition and management of a known complication but cannot quantify how often HIT occurs, compare anticoagulants, or speak to medicinal-leech treatment, and the authors note HIT can recur rapidly on heparin re-exposure even years later.
Citation
Heparin-induced thrombocytopenia requiring VA-ECMO management during percutaneous coronary intervention for acute coronary syndrome: A case report.
Kawamura et al. · Journal of cardiology cases, 2024
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