Subacute stent thrombosis associated with a heparin‐coated stent and heparin‐induced thrombocytopenia

Abstract

Subacute stent thrombosis occurred in a patient 34 days after receiving a heparin-coated (HC) stent. The patient developed heparin-induced thrombocytopenia and diffuse thrombosis after the stent was placed. This raises the concern that patients who develop heparin-associated antibodies in the context of a recently placed HC stent may have an increased risk for subacute stent thrombosis.

HITT and stent thrombosis: A “CLINICAL” diagnosis not to be missed

“…Two previous cases of stent thrombosis have been reported secondary to HITT [1,2]. HITT is primarily a clinical diagnosis which is then confirmed with an antibody or functional platelet activation or aggregation assay [3].…”

Simple surface modification of a titanium alloy with silanated zwitterionic phosphorylcholine or sulfobetaine modifiers to reduce thrombogenicity

“…While DLC coatings have also demonstrated good hemocompatibility and durability independently of comparative studies with MPC, they also carry the risk of microcrack formation [16]. Unlike heparin coated surfaces, MPC copolymer coatings have not been shown to present a potential risk for heparin-induced thrombocytopenia and should be less susceptible to degradative enzymatic process that can act on heparin [17–19]. However physically adsorbed PC group-bearing polymer coatings are not as stable as DLC coatings and the concern of surface stability in long-term applications may offset its perceived advantages.…”

Evaluation of appropriate serologic testing for suspected heparin-induced thrombocytopenia

“…catheters, which have been known to cause HIT and consequent thrombotic complications. [26][27][28][29] Among the 24 ELISA-positive patients whose records were evaluated in our study, the charts of only 15 (63%) noted heparin allergy at the time of the study. Appropriate documentation of allergies is important to ensure patient safety, and research indicates that the administration of medications to which patients are allergic underlies an estimated 1.5-8% of all adverse drug events.…”