Unusual onset of venous thromboembolism and heparin-induced thrombocytopenia in a patient with essential thrombocythemia

Arterial and venous complications are major causes of morbidity and mortality in myeloproliferative neoplasms (MPNs). MPNs patients, frequently receive heparin. Heparin-induced thrombocytopenia (HIT) is a rare but potentially life-threatening complication resulting in a severe acquired thrombophilic condition. We carried out a retrospective analysis to evaluate occurrence of new thrombotic events during heparin therapy in essential thrombocythemia (ET) patients. We studied 108 ET patients on heparin for treatment of previous thrombotic events or in thromboprophilaxis. Fifty-eight of them carried JAK 2 V617F mutation while 50 patients were without V617F mutation. Ten patients, among those with JAK 2 V617F mutation after a median of 10 days from heparin treatment presented a platelet drop, new thrombotic events and in 10/10 cases heparin-related antibodies were found. In the other group, two patients (4%) presented a platelet drop, thrombotic manifestations and heparin related antibodies. Our data show that HIT is more frequent, during heparin treatment, in patients with ET carrying V617F mutation, as compared with patients without mutations (P = 0.029). ET with V617F mutation seems to be associated with higher risk of thrombotic complications during heparin treatment. Monitoring platelet counts very closely during the course of heparin is essential especially in ET patients in which platelet drop may be hidden by constitutional thrombocytosis.

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“…Anecdotal data on relationship between HIT and MPNs are reported [26], but few studies have systematically approached the problem. [27][25].…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that the observed risk of HIT is higher in patients with MPNs. [24] [25][26][27]. The aim of our study is to evaluate the occurrence of new thrombotic events among patients with ET with JAK2 V617F mutation treated with un-fractioned (UFH) or low molecular weight heparin (LMWH).…”

Section: Introductionmentioning

confidence: 99%

High prevalence of heparin induced thrombocytopenia with thrombosis among patients with essential thrombocytemia carrying V617F mutation

Castelli

Gallipoli

Schiavon

et al. 2017

J Thromb Thrombolysis

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“…ET can be asymptomatic, and bone marrow biopsy as workup for thrombocytopenia (HIT) can reveal an unusual combination of ET and HIT [ 12 ]. To avoid the delay in diagnosis and its attendant complication, delta change in platelet count rather than the absolute value should be considered and evaluated whilst considering the diagnosis of HIT in the setting of ET [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

Noel

Abbas

et al. 2015

Case Reports in Hematology

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Vascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started. She was exposed to unfractionated heparin (UFH) 5 days prior to this admission. Decrease in platelet count was noted, and HIT panel was sent. Heparin was discontinued. Patient developed atrial fibrillation, and Dabigatran was started. On day three, patient also developed multiple tiny cerebral infarctions and acute right popliteal DVT. On day ten of admission, HIT panel was positive, and Dabigatran was changed to Lepirudin. Two days later, Lepirudin was also discontinued because patient developed pseudoaneurysm on the right common femoral artery at the site of cardiac catheterization access. A progressive increase in the platelet count was noted after discontinuing heparin. Physicians should be aware of the coexistence of HIT and ET, accompanied challenges of the prompt diagnosis, and initiation of appropriate treatment.

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Current awareness: Pharmacoepidemiology and drug safety

2010

Pharmacoepidem. Drug Safe.

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Unusual onset of venous thromboembolism and heparin-induced thrombocytopenia in a patient with essential thrombocythemia

Cited by 8 publications

References 26 publications

High prevalence of heparin induced thrombocytopenia with thrombosis among patients with essential thrombocytemia carrying V617F mutation

High prevalence of heparin induced thrombocytopenia with thrombosis among patients with essential thrombocytemia carrying V617F mutation

Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

Current awareness: Pharmacoepidemiology and drug safety

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