Heparin-induced thrombocytopenia with acute aortic and renal thrombosis in a patient treated with low-molecular-weight heparin
Case report published in Eur J Vasc Endovasc Surg (2005)
Abstract
Heparin-induced thrombocytopenia is a rare but serious complication of heparin therapy. Most of cases are related to unfractionated heparin, but a few are due to low molecular weight heparin sometimes associated with unfractionated heparin. A patient with pulmonary contusions after chest injury developed a catheter related subclavian vein thrombosis on day 16. He was treated by increasing doses of low molecular weight heparin. Aortic and renal thromboses occurred on day 21. Surgical thrombectomy, performed after starting alternative anticoagulation treatment led to complete arterial recovery. In case of suspicion of heparin-induced thrombocytopenia, with unfractionated or low-molecular-weight heparin, heparin treatment must be discontinued before the results of biological tests become available. Arterial and/or venous thrombosis is a serious complication of heparin-induced thrombocytopenia. The treatment has two aims: first, to restore arterial patency by clot removal by thrombectomy, bypass or thrombolysis, and second, to avoid new thrombosis formation by substitutive anticoagulation treatment: danaparoid may have cross-reaction with heparin, or lepirudin has anaphylactic risks and needs biological follow-up. Heparin-induced thrombocytopenia and thrombosis can be complicated by death or disabilities such as amputations, stroke, renal or bowel infarction. Once HIT has been diagnosed heparin should never be given again, but if cardiopulmonary bypass is required, it might be reintroduced during operation only if serum antibodies have disappeared.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Polytrauma patient developed HIT and acute aortic/renal thrombosis after LMWH; surgical thrombectomy under alternative anticoagulation including lepirudin restored arterial patency.
Por qué esto importa para la hirudoterapia
Este caso clínico describe una trombocitopenia inducida por heparina (TIH) complicada por trombosis aórtica y renal agudas en un paciente traumatológico que recibía heparina de bajo peso molecular, tratado con trombectomía quirúrgica y anticoagulación alternativa. El resumen identifica específicamente la lepirudina — hirudina recombinante derivada de la sanguijuela medicinal Hirudo medicinalis — como una opción de anticoagulante sustituto en la TIH, al tiempo que destaca su riesgo anafiláctico y la necesidad de monitorización biológica. Para la ASH y la hirudoterapia, esto ilustra un contexto clínicamente significativo en el que un anticoagulante derivado del secretoma de la sanguijuela actúa como alternativa terapéutica reconocida cuando la heparina está contraindicada debido a complicaciones trombóticas potencialmente mortales. La advertencia honesta es que se trata de un caso clínico único que documenta opciones de manejo, no un estudio de eficacia de la lepirudina u otras terapias basadas en hirudina; el resumen menciona la lepirudina solo como una opción junto con sus riesgos.
Citación
Heparin-induced thrombocytopenia with acute aortic and renal thrombosis in a patient treated with low-molecular-weight heparin.
Chevalier J et al. · European journal of vascular and endovascular surgery, 2005
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026