Heparin-Induced Thrombocytopenia After Mitral Valve Replacement
Case report published in Ochsner journal (2021)
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a rare autoimmune reaction that involves a decrease in platelet count following heparin exposure and can be associated with life-threatening thrombosis. Because of their prolonged heparin exposure, patients undergoing cardiac surgery are at risk of HIT, with an incidence of 0.1% to 3%. Case Report: A 65-year-old male with severe mitral regurgitation and preoperative ejection fraction of 20% to 25% underwent mitral valve bioprosthetic replacement with coronary artery bypass graft surgery. Heparin anticoagulation was started on postoperative day (POD) 1. Respiratory failure resulted in prolonged mechanical ventilation and heparinization without the ability to initiate warfarin. While the patient was on heparin, his platelet count declined on POD 2 and then steadily increased to above the preoperative level on POD 7. On POD 10, the patient's platelet count dramatically decreased, and on POD 13 he developed acute common femoral artery occlusion necessitating embolectomy. Intraoperative transesophageal echocardiography revealed heavy thrombus burden across the mitral bioprosthesis. HIT was confirmed with a positive heparin-induced platelet antibody and serotonin release assay. Heparin was stopped and argatroban initiated. The patient underwent reoperative bioprosthetic mitral valve replacement on POD 18 using bivalirudin intraoperatively. Despite resolution of HIT, the patient developed sepsis and died on POD 59. Conclusion: The diagnosis of HIT is challenging in patients who undergo cardiopulmonary bypass. Platelet counts often decrease 40% to 60% during the first 72 hours postoperatively, and the frequency of nonspecific anti-platelet factor 4/heparin antibody formation is high. These findings can mask early signs of HIT and delay diagnosis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Heparin-induced thrombocytopenia (HIT) is a rare autoimmune reaction that involves a decrease in platelet count following heparin exposure and can be associated with life-threatening thrombosis.
Por qué esto importa para la hirudoterapia
Este caso clínico describe un varón de 65 años que desarrolló trombocitopenia inducida por heparina (TIH) tras cirugía de reemplazo de la válvula mitral, confirmada por anticuerpos antiplaquetarios inducidos por heparina positivos y por un ensayo de liberación de serotonina, requiriendo finalmente una reintervención de reemplazo valvular con anticoagulación con bivalirudina. El caso destaca los desafíos diagnósticos de la TIH en pacientes de cirugía cardíaca, donde las fluctuaciones rutinarias del recuento plaquetario postoperatorio y la formación frecuente e inespecífica de anticuerpos anti-PF4/heparina pueden enmascarar los signos tempranos de la enfermedad. Para el ámbito de la ASH, este informe ilustra un escenario clínico en el que los anticoagulantes alternativos deben sustituir a la heparina —un paralelo farmacológico con los principios anticoagulantes subyacentes a la hirudoterapia, aunque no se emplearon anticoagulantes derivados de la sanguijuela. El artículo no involucra sanguijuelas ni sustancias derivadas de la sanguijuela y carece de relevancia directa para la hirudoterapia. Se trata de un caso clínico único, lo que limita su generalización.
Citación
Heparin-Induced Thrombocytopenia After Mitral Valve Replacement
Tugulan C et al. · Ochsner journal, 2021
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026