Background Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse drug reaction characterized by thrombocytopenia and thromboembolism. Herein, we present a case of HIT with subcutaneous hemorrhage after cardiovascular interventional therapy. Case presentation A 74-year-old man was admitted to the hospital for elective atrial fibrillation (AF) catheter ablation and left atrial appendage closure because of intermittent dizziness and palpitations. At presentation, the routine laboratory test results showed no abnormalities. He received subcutaneous enoxaparin for stroke prevention and unfractionated heparin for intraprocedural anticoagulation during coronary angiography and the AF procedure. On the second day after the AF procedure, the patient developed profound thrombocytopenia, moderate anemia, and mild subcutaneous hematoma. Blood tests and imaging examinations excluded acute hemolysis and other active bleeding. A 4Ts score of 5 and markedly positive platelet factor 4 IgG antibody established the diagnosis of HIT. Due to progressive subcutaneous hemorrhage in the thighs that could not be suppressed by pressure dressing, the patient received platelet transfusion and rivaroxaban for anticoagulation. The following days, the patient remained clinically stable from the hemorrhage, and his platelet count recovered. No thrombotic events occurred during hospitalization or follow-up. Conclusion This case emphasizes the significance of suspecting HIT in patients with unexplained rapid thrombocytopenia after frequent heparin exposure. Decision-making regarding alternative anticoagulation and platelet transfusion in HIT with hemorrhage must be based on unique patient characteristics.

Background: Coronary computed tomography-derived fractional flow reserve (FFR-CT) assesses whether coronary artery lesions will result in myocardial ischemia. Aim: This study aimed to evaluate the predictive value of FFR-CT for cardiovascular events in patients with coronary artery disease (CAD). Methods: Data were collected retrospectively from patients with CAD who underwent FFR-CT at our hospital from January 2020 to February 2022 (1-year average follow-up). Patients were divided into ischemic (FFR-CT ≤ 0.80) and non-ischemic (FFR-CT > 0.80) groups. The incidence of endpoint events (cardiac death, acute myocardial infarction, unplanned revascularization, unstable angina, and stable angina) was calculated. The FFR-CT value was correlated with endpoint events using Cox regression models and Kaplan-Meier survival curves. Results: We recruited 134 patients (93 [69.4%] and 41 [30.6%] patients in the ischemic and non-ischemic groups, respectively). Compared to the non-ischemic group, the ischemic group had a higher proportion of men, patients with type 2 diabetes and hypertension, and patients taking antiplatelet drugs and β-blockers (all P < 0.05). Other parameters were comparable. Multivariate Cox regression analysis revealed no significant differences between the groups for cardiac death, acute myocardial infarction, unplanned revascularization, and unstable angina; the incidence of stable angina events (HR=3.092, 95% CI: 1.362–7.022, P = 0.007) was significantly higher in the ischemic group. Kaplan-Meier survival analysis identified a significant difference in event-free survival for stable angina between the groups (P = 0.002). Conclusion: FFR-CT showed an independent predictive value for stable angina within 1 year of examination in patients with CAD.

Background: Secondary prevention therapy reduces death and re-infarction after acute myocardial infarction (AMI) but is under-utilized in clinical practice. Mechanisms for this therapeutic gap are not well established. We aimed to evaluate the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI patients during index hospitalization. Methods: We analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, clopidogrel, beta-blockers, statins, angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARBs)). Multivariate analysis was used to identify independent predictors of discharge and 6-month medication, Kaplan-Meier survival curve was used to evaluate 12-month survival. Results: Overall prescription rates of aspirin, clopidogrel, beta-blockers, statins, ACEI/ARBs on discharge was 94.8%, 54.2%, 64.5%, 83.5% and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy, except clopidogrel, was an independent predictor of prescription of the same therapy on discharge: aspirin [Odds ratio (OR) =4.8, 95% CI =1.9-12.3, P<0.01]; beta-blockers (OR=2.5, 95%CI =1.8-3.4, P<0.01); statins (OR=8.3, 95%CI =0.4-15.7, P<0.01) and ACEI/ARBs (OR=2.9, 95%CI =2.0-4.3, P<0.01). Passive continuation of prior medication was associated with higher 1-year mortality rates than active initiation in treatment naïve patient [aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), statins (11.0% vs. 4.6%), all P<0.01].Active prescription was more common in lower risk patients (who were younger, with less co-morbidity, and with higher left ventricular ejection fraction) who were treated more aggressively with secondary prevention medication on discharge. Also patients who were not on a given medication before admission were less likely to be prescribed it on discharge.Conclusions: Overall use of secondary prevention medication for AMI was suboptimal compared to guideline recommendations. Our findings suggested the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to those who received secondary preventive medication for the first time during index hospitalization. Failure to start additional medication and possible inadequate dose titration in the passive continuation group may be in part the reason for the poorer clinical outcome in this group.