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Thorac Cardiovasc Surg 2013; 61(06): 537-540
DOI: 10.1055/s-0032-1328930
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Recurrent Left Atrial and Left Ventricular Thrombosis Due to Heparin-Induced Thrombocytopenia: Case Report and Short Review

Thomas Kuhl
1   HELIOS Klinikum Krefeld, Department of Cardiology (Med. Klinik I) Krefeld, Germany
,
Stefanie Wendt
2   Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Georg Langebartels
2   Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Axel Kröner
2   Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Thorsten Wahlers
2   Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

06 May 2012

09 July 2012

Publication Date:
19 February 2013 (online)

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Abstract

The combination of heparin-induced thrombocytopenia (HIT) II, left ventricular failure with extracorporeal membrane oxygenation (ECMO) therapy, and recurrent left ventricular thrombosis is rare and predicts a poor outcome. In this case, HIT II occurred after an ischemic cardiogenic shock. We initiated ECMO and intra-aortic balloon pump therapy during coronary artery bypass grafting and ventricular thrombectomy. Despite continued therapeutic therapy with heparin and later argatroban, the patient developed solid and recurrent thrombotic masses in the left atrium and left ventricle.

Keywords

blood - coagulation/anticoagulation - circulatory assist devices - extracorporeal membrane oxygenation - ECMO - intensive care - myocardial infarction - echocardiography
 

  • References

  • 1 Greinacher A. Heparin-induced thrombocytopenia. J Thromb Haemost 2009; 7 (Suppl. 01) 9-12
    CrossrefPubMedGoogle Scholar
  • 2 Greinacher A. Heparin-induced thrombocytopenia: frequency and pathogenesis. Pathophysiol Haemost Thromb 2006; 35 (1–2) 37-45
    CrossrefPubMedGoogle Scholar
  • 3 Pouplard C, Regina S, May MA, Gruel Y. Heparin-induced thrombocytopenia: a frequent complication after cardiac surgery. Arch Mal Coeur Vaiss 2007; 100 (6–7) 563-568
    PubMedGoogle Scholar
  • 4 Nowak G. Heparin-induced thrombocytopenia (HIT II) - a drug-associated autoimmune disease. Thromb Haemost 2009; 102 (5) 887-891
    PubMedGoogle Scholar
  • 5 Castelli R, Cassinerio E, Cappellini MD, Porro F, Graziadei G, Fabris F. Heparin induced thrombocytopenia: pathogenetic, clinical, diagnostic and therapeutic aspects. Cardiovasc Hematol Disord Drug Targets 2007; 7 (3) 153-162
    CrossrefPubMedGoogle Scholar
  • 6 Selleng S, Malowsky B, Strobel U , et al. Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to heparin-induced thrombocytopenia, even when antibody tests are positive. J Thromb Haemost 2010; 8 (1) 30-36
    CrossrefPubMedGoogle Scholar
  • 7 Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4 (4) 759-765
    CrossrefPubMedGoogle Scholar
  • 8 Moubarak G, Weiss N, Leprince P, Luyt CE. Massive intraventricular thrombus complicating extracorporeal membrane oxygenation support. Can J Cardiol 2008; 24 (1) e1
    CrossrefPubMedGoogle Scholar
  • 9 Beiderlinden M, Treschan T, Görlinger K, Peters J. Argatroban in extracorporeal membrane oxygenation. Artif Organs 2007; 31 (6) 461-465
    CrossrefPubMedGoogle Scholar