Heparin‐induced thrombocytopenia and thrombosis: Reversal with streptokinase a case report and review of literature

Abstract

Heparin-induced thrombocytopenia and thrombosis is associated with a significant incidence of morbidity and mortality. Prompt recognition of this complication and immediate withdrawal of heparin therapy are imperative. This report describes a case of heparin-induced thrombosis and thrombocytopenia with major vascular insufficiency of the extremities. This is the first reported instance of the use of intravenous streptokinase for the treatment of heparin-induced venous thrombosis.

Heparin‐induced thrombocytopenia with thrombosis: Incidence, analysis of risk factors, and clinical outcomes in 108 consecutive patients treated at a single institution

“…Most investigators consider stopping heparin as the single most important step in the treatment of HITT. Numerous treatments, which include antiplatelet agents, anticoagulants, thrombolytic therapy, hirulog, heparan sulfate, ancrod, synthetic antithrombins, and surgical interventions have been tried in patients with HITT [30][31][32][33][34][35][36][37]. However, there are no studies that show if therapy influences the final outcome.…”

Newer Strategies for the Treatment of Heparin‐Induced Thrombocytopenia

“…Thrombolytic therapy can be effective in selected patients. 47 Aspirin and other antiplatelet agents have only modest in vitro inhibitory effects on potent plateletactivating properties of platelet-aggregating antibody in patients with HIT, and should not be primary therapy.…”

Catastrophic heparin-induced thrombocytopenia/thrombosis syndrome related to the use of a Port-A-Cath in a breast cancer patient receiving chemotherapy

“…Warfarin, low molecular weight heparin, and ancrod should be avoided because they may exacerbate the underlying prothrombotic state [1,9]. Selected patients with life-or limb-threatening thrombosis may benefit from adjuvant therapies including thrombolytic drugs, surgical thromboembolectomy, intravenous immune globulin, plasmapheresis, and antiplatelet agents [10,11,12]. In our patient, heparin was promptly stopped but it did not halt the thrombotic process and progressive limb ischemia, necessitating consideration of a possible fasciotomy to restore circulation.…”