Unusual presentation of heparin-induced thrombocytopenia and thrombosis (HITT) with multiple organ involvement
Research article published in BMJ case reports (2025)
Abstract
In this case, a woman in her 60s was diagnosed with heparin-induced thrombocytopenia (HIT) following the use of prophylactic enoxaparin postoperatively. Subsequently, she developed bilateral pulmonary emboli (PE), hepatic vein thrombosis and bilateral adrenal infarcts. On initiating warfarin therapy, she developed right leg deep vein thrombosis (DVT). She was successfully bridged onto warfarin with an argatroban infusion and has not developed any further thrombosis since being discharged on warfarin single-agent treatment. Her care required a multidisciplinary approach involving input from specialist haematologists at the local tertiary centre as well as endocrinologists, gastroenterologists, respiratory physicians and orthogeriatricians. This report serves as a key reminder of the many complications of HIT. Additionally, it reminds us to consider the paradoxical procoagulant state seen in early warfarinisation and the potential consequences of this.
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 medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This case report describes a woman in her 60s who developed heparin-induced thrombocytopenia (HIT) after prophylactic enoxaparin, going on to suffer bilateral pulmonary emboli, hepatic vein thrombosis, bilateral adrenal infarcts and a deep vein thrombosis during early warfarinisation, and who was ultimately stabilised by bridging onto warfarin with an argatroban infusion. For the medicinal-leech evidence picture it is a useful reminder of why a non-heparin anticoagulant pathway matters: HIT forces clinicians toward direct thrombin inhibitors (argatroban here), the same mechanistic class as the leech-derived peptide hirudin, which does not provoke the heparin-PF4 antibody response. As a single-patient case report it illustrates a clinical problem and management sequence only and supports no general claim about leech therapy or hirudin-based agents.
Citation
Unusual presentation of heparin-induced thrombocytopenia and thrombosis (HITT) with multiple organ involvement.
Zakhour H et al. · BMJ case reports, 2025
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