Percutaneous Coronary Intervention in Patients with Heparin Induced Thrombocytopenia: Case Report and Review of Literature

Abstract

Heparin Induced Thrombocytopenia (HIT) is a rare disorder, which manifests as acute onset thrombocytopenia within five to fifteen days after exposure to heparin. The milder version of the disease may manifest as asymptomatic thrombocytopenia, which resolves with cessation of heparin. The more severe form presents with arterial and venous thrombi, profound thrombocytopenia and is associated with devastating consequences such as myocardial infarction, stroke, limb ischemia etc. The management of patients with HIT undergoing revascularization in the form of Percutaneous Coronary Intervention (PCI) and/or Coronary Artery Bypass Grafting (CABG) can be challenging and complicated by acute stent thrombosis and early graft closure. Management strategy consists of immediate discontinuation of all heparin products, alternative anticoagulation, and lifelong avoidance of heparin products. Here we describe the various challenges specifically associated with coronary re-vascularization in these patients, and the current treatment options available.

Thrombocytopenia and prospective endovascular intervention in a patient with coronary artery disease

“…Развитие ТП через несколько дней после ЧКВ чаще связывают с действием гепарина, влиянием протамина, с псевдотромбоцитопенией или действием ингибиторов гликопротеина IIb/IIIa. В случае ТП через недели после ЧКВ следует рассмотреть действие гепарина (редко) или псевдотромбоцитопению [14].…”

“…Более тяжелая ТП требует взвешенного решения о соотношении риска ишемии и геморрагии с оценкой факторов риска (шкалы SMOG, 4Ts) [13][14][15], вторичных рисков, обусловленных сопутствующей патологией. В данной ситуации пользу может принести мониторирование состояния агрегации тромбоцитов.…”