Heparin-induced Thrombocytopenia During Multiple Extracorporeal Mechanical Support for Fulminant Myocarditis: A Case Report with a Literature Review

Case report published in Internal Medicine (2026)

Última actualización: June 18, 2026Revisado por: ASH Editorial Board

Research article — evidence reviewArticle reference

Evidence: Research reportEnsayos clínicosDesarrollo de fármacosMorita Y et al. · Internal Medicine (Tokyo), 2026

Abstract

Heparin-induced thrombocytopenia (HIT) is a potentially fatal complication of heparin therapy, particularly during extracorporeal mechanical support requiring anticoagulation. We report the case of a 57-year-old woman with fulminant myocarditis complicated by acute kidney injury who was transferred while receiving extracorporeal membrane oxygenation and continuous renal replacement therapy with unfractionated heparin. After transfer, a rapid platelet decline and repeated circuit occlusions raised a strong suspicion of HIT based on the 4Ts score. Heparin was replaced with nafamostat mesilate or argatroban, and HIT antibodies were detected. Both bleeding and thrombotic complications occurred during intensive care, thus reflecting the complexity of managing critically ill patients receiving multiple extracorporeal mechanical supports.

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

Publication typeJournal Article

Resumen

Fulminant myocarditis on ECMO and CRRT complicated by HIT with rapid platelet decline and repeated circuit occlusion; heparin replaced with nafamostat mesilate or argatroban, illustrating the complexity of HIT management during multi-modal extracorporeal support.

Por qué esto importa para la hirudoterapia

This case report describes a 57-year-old woman on ECMO and continuous renal replacement therapy who developed suspected heparin-induced thrombocytopenia (HIT), requiring transition from unfractionated heparin to nafamostat mesilate or argatroban, with HIT antibodies subsequently confirmed. The report is indirectly relevant to ASH's domain insofar as it illustrates the clinical challenge of anticoagulation in extracorporeal support when heparin fails—a scenario where direct thrombin inhibition (the mechanism of leech-derived hirudin) is conceptually pertinent. CAVEAT: This article does not involve leeches, hirudotherapy, or bivalirudin; the alternative agents used (nafamostat, argatroban) are not leech-derived, making the relevance to hirudotherapy entirely indirect and conceptual.

Citación

Heparin-induced Thrombocytopenia During Multiple Extracorporeal Mechanical Support for Fulminant Myocarditis: A Case Report with a Literature Review.

Morita Y et al. · Internal Medicine (Tokyo), 2026

DOI

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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026