Heparin-Induced Thrombocytopenia in a Patient With Pulmonary Embolism and Bilateral Deep Venous Thrombosis: A Case Report

The main non-bleeding complication arising from exposure to heparin is heparin-induced thrombocytopenia (HIT). Type I HIT is a non-immune-mediated mild decrease in platelet count, which mostly does not need treatment, and type II HIT is an immune-mediated, severe decrease in platelet count characterized by a significant risk of thrombotic complications requiring immediate treatment. HIT type II is a serious condition that can threaten life due to an immune and thrombotic response that continues to pose diagnostic and management challenges. Due to ineffective alternatives to heparin in certain typical and recurring situations, the disease burden remains unchanged in the U.S. HIT occurs in about 20,000 cases annually, representing one in every 1,500 hospital admissions. For patients diagnosed with pulmonary embolism (PE), heparin is often employed as an anticoagulant; however, the emergence of HIT in these cases complicates both the treatment plan and management approach. This case illustrates a patient who was diagnosed with a PE and received heparin therapy. Shortly after starting treatment, the patient experienced thrombocytopenia, a key indicator of HIT. A 73-year-old male, while on admission, was noticed to have left upper extremity swelling and increased shortness of breath. A CT chest pulmonary angiogram revealed a positive for acute pulmonary artery embolus in the right lower lobar branch pulmonary artery. Vascular Laboratory (VL) left upper extremity duplex revealed acute occlusive deep venous thrombosis (DVT) of the left jugular, subclavian, axillary, and brachial veins and superficial vein thrombosis in basilic and cephalic veins. The patient received an IV heparin bolus and continued on heparin infusion. The platelet count on initiating the heparin drip was 145 K/μL. On hospital day 5, the patient's platelet count dropped to 98 K/μL.The 4Ts for HIT score calculated was 7 points, meaning high probability, and heparin-induced platelet (HIP) antibody was ordered, and heparin drip was discontinued. Argatroban infusion was started. The Hematologist evaluated the patient and stated that the clinical findings were consistent with HIT. The HIP antibody (screening test) resulted positive, and the patient's optical density (O.D) was elevated to 0.536. Later on, the patient was noted to have right upper extremity swelling, and VL duplex upper extremity right veins showed acute occlusive DVT involving the right subclavian vein, axillary vein, brachial vein, and internal jugular vein, and a drop in platelet count to 54 K/μL. The unfractionated heparin (UFH) serotonin release assay, which is the confirmatory test for HIT, resulted positive result. Argatroban dose was increased to the maximum of the therapeutic range, aiming for a partial thromboplastin time of 70-80, as the patient continued to experience thromboses. This led to the recovery of platelets, discontinuation of Argatroban, and transition of the patient to Eliquis.

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

Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Узнайте, как это исследование связано с клинической практикой

More peer-reviewed studies in Клинические исследования.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Wound healing potential of bark paste of Pongamia pinnata along with hirudotherapy: A case report — Balasooriya D, Karunarathna C, Uluwaduge I (2021)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• Study on the effect of medicinal leech therapy (Hirudo medicinalis) on full-thickness excisional wound healing in the animal model — Zakian A et al. (2022)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis — Aminov R, Frolov A, Aminova A (2022)
• Recombinant hirudin in clinical practice: focus on lepirudin — Greinacher A, Lubenow N (2001)

Browse all ASH-analysed research →