Trombocitopenia inducida por heparina y trombosis de la vena porta en pacientes con carcinoma hepatocelular tras hepatectomía: un caso clínico

Portal vein thrombosis and heparin-induced thrombocytopenia (HIT) caused by postoperative heparin administration is a potentially fatal disease. There have been a few cases of portal vein thrombosis and HIT developing after hepatectomy. We report a rare case of HIT and portal vein thrombosis after hepatectomy. A 79-year-old woman with liver cirrhosis and hypertension was referred to our hospital for the evaluation of the elevated tumor marker and liver tumor diagnosed by ultrasonography. In laboratory findings, alpha-fetoprotein and protein induced by vitamin K absence were elevated. Contrast-enhanced computed tomography (CT) scan findings showed that 28 mm and 17 mm diameter, round-shaped tumors enhanced heterogeneously with infiltration in the left hepatic vein and pulmonary embolization. Hepatocellular carcinoma and pulmonary embolism were diagnosed. She underwent lateral segmentectomy along with venous tumor embolus resection. Pathological findings showed that the tumor was moderate to well-differentiated adenocarcinoma invading the capsule with liver cirrhosis. Tumor embolization was suspected preoperatively to be an organizing thrombus. After surgery, she was treated with heparin for the prevention of deep venous thrombosis. At postoperative day 15, the sudden onset of the decline of platelets, the activity of antithrombin III, and the elevation of D-dimer were found. On physical examination, there were no symptoms. The 4T's score was 7. CT scan showed a portal vein thrombosis. The antibody for HIT was elevated. HIT was diagnosed. We stopped the heparin and started the argatroban administration. The platelet level increased to the normal range, and the D-dimer level decreased. After the reduction of portal vein and pulmonary thrombosis, she was discharged from the hospital on postoperative day 28.

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Mujer de 79 años con cirrosis hepática, carcinoma hepatocelular y embolia pulmonar; tras segmentectomía lateral recibió heparina para prevenir trombosis venosa profunda. En el día 15 posoperatorio descendieron las plaquetas y la antitrombina III y aumentó el dímero D; con puntuación 4T de 7, trombosis portal en la TC y anticuerpos elevados se diagnosticó trombocitopenia inducida por heparina (TIH). Tras cambiar a argatrobán, las plaquetas se normalizaron y fue dada de alta el día 28.

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