Published online Dec 26, 2020. doi: 10.4330/wjc.v12.i12.634
Peer-review started: September 9, 2020
First decision: October 5, 2020
Revised: October 10, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: December 26, 2020
Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin therapy, and is characterized by arteriovenous thrombosis and bleeding events. The incidence of HIT after percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated with renal failure is rarely reported.
We report a 73-year-old man with acute myocardial infarction and renal failure who underwent hemodialysis and PCI, and developed a progressive decline in platelets and subcutaneous hemorrhage of both upper limbs after heparin treatment. In addition to a gradual decrease in platelets, the patient’s 4T's score was 7, and HIT antibody was positive, confirming the diagnosis of HIT.
Patients receiving heparin combined with antiplatelet therapy should be monitored closely, especially for their platelet count. In the case of thrombo-cytopenia, HIT should be highly suspected. When the diagnosis of HIT is confirmed, timely individualized treatment should be delivered.
Core Tip: Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin therapy. Its pathogenesis includes thrombotic events that can rarely affect the coronary arteries. We report a 73-year-old man who presented with extensive lower extremities deep venous thrombosis. After being treated with heparin, he developed ST-elevation myocardial infarction secondary to acute thrombus formation. The patient’s platelets dropped within 6 d, and heparin-platelet factor 4 immunoglobulin G antibody and serotonin release assay were positive, confirming the diagnosis of HIT. HIT is associated with an increased risk for coronary thrombosis and ischaemia. HIT can cause coronary complications usually in previously disrupted coronary vessels and bypass grafts.