Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute Stent Thrombosis

Voudris, Vassilis; Γεωργιάδου, Παναγιώτα; Kalogris, Panagiotis; Kostelidou, Theodora; Karabinis, Andréas; Gerotziafas, G.

doi:10.12659/ajcr.914988

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…Insufficient use or premature discontinuation of antiplatelet drugs and clopidogrel resistance are also major causes of thrombosis after PCI. In recent years, cases of AST secondary to heparin-induced thrombocytopenia have been reported frequently[ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Acute coronary artery stent thrombosis caused by a spasm: A case report

Meng¹,

Wang²,

Peng³

2022

WJCC

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BACKGROUND Acute stent thrombosis (AST) is a serious complication of percutaneous coronary intervention (PCI). The causes of AST include the use of stents of inappropriate diameters, multiple overlapping stents, or excessively long stents; incomplete stent expansion; poor stent adhesion; incomplete coverage of dissection; formation of thrombosis or intramural hematomas; vascular injury secondary to intraoperative mechanical manipulation; insufficient dose administration of postoperative antiplatelet medications; and resistance to antiplatelet drugs. Cases of AST secondary to coronary artery spasms are rare, with only a few reports in the literature. CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d. He was diagnosed with coronary heart disease and acute myocardial infarction (AMI) based on electrocardiography results and creatinine kinase myocardial band, troponin I, and troponin T levels. A 2.5 mm × 33.0 mm drug-eluting stent was inserted into the occluded portion of the right coronary artery. Aspirin, clopidogrel, and atorvastatin were started. Six days later, the patient developed AST after taking a bath in the morning. Repeat coronary angiography showed occlusion of the proximal stent, and intravascular ultrasound showed severe coronary artery spasms. The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty. Postoperatively, he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST. He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment. CONCLUSION Coronary spasms can cause both AMI and AST. For patients who exhibit coronary spasms during PCI, diltiazem administration could reduce spasms and prevent future AST.

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Section: Discussionmentioning

confidence: 99%

Acute coronary artery stent thrombosis caused by a spasm: A case report

Meng¹,

Wang²,

Peng³

2022

WJCC

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“…We assess that in our case any HIT-related drop in platelets was masked by a post-haemorrhagic thrombopoetic recovery. In a similar reported case this led to life threatening acute stent thrombosis that could not be solved by PCI and required immediate surgical revascularization [ 14 ]. A very recent case report by Mele et al characterized this scenario as “easy to miss, uneasy to prevent” [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Near fatal stent thrombosis in an aneurysmatic RCX as first manifestation of heparin induced thrombocytopenia (HIT) without thrombocytopenia

Zoller

Atmowihardjo

Huch

et al. 2021

BMC Cardiovasc Disord

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Background Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention. Case presentation A supposedly “completely healthy” 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis. Conclusions The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.

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Antiplatelets/antithrombotics

2019

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Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute Stent Thrombosis

Cited by 6 publications

References 24 publications

Acute coronary artery stent thrombosis caused by a spasm: A case report

Acute coronary artery stent thrombosis caused by a spasm: A case report

Near fatal stent thrombosis in an aneurysmatic RCX as first manifestation of heparin induced thrombocytopenia (HIT) without thrombocytopenia

Antiplatelets/antithrombotics

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