Heparin-induced thrombocytopenia in patients with diffuse-generalized form of hypertrophic cardiomyopathy after bypass surgery
Abstract Heparin-induced thrombocytopenia (HIT) is a rare complication that occurs in no more than 5% of patients receiving unfractionated heparin (UFH), mainly after cardiac or orthopedic surgery. In this article we presented a 38 years observation of the patient, which in the presence of a diffuse background – a generalized form of hypertrophic cardiomyopathy (HCM) in conjunction with the syndrome of connective – tissue dysplasia in the post operative period, developed a serious complication of heparin-induced thrombocytopenia. Due to lack of awareness, lack of laboratory tests HIT rarely diagnosed at the hospital stage, which affects the accuracy of treatment and prognosis. The article reflects the experience of the diagnostic approach and the important elements of the clinical and laboratory evaluation of HIT patient after an extended myectomy with mitral valve replacement.
Keywords:diffusely-generalized HCM, heparin-induced trobotsitopeniya, genetic testing
Clin. Experiment. Surg. Petrovsky J. 2015. № 2. Р. 77–82.
References
1. Jang I.K., Hursting M.J. When heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation. 2011; Vol. 20: 2671–83.
2. Yirsh J., Warkentin T.E., Shaughnessy S.G., et al. Heparin and low-molecular weight heparin: mechanism of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001; Vol. 119: 64–94.
3. Morris T.A., Castrejon S., Devendra G., Gamst A.C. No difference in risk for thrombocytopenia during treatment of pulmonary embolism and deep venous thrombosis with either low-molecular- weight heparin or unfractionated heparin: a meta-analysis. Chest. 2007; Vol. 132: 1131–9.
4. Harenberg J., Jorg I., Fenyvess T. Heparin-induced thrombocytopenia: pathphysiology and new treatment options. Pathophysiol Haemost Thromb. 2002; Vol. 32: 289–94.
5. Warkentin T.E., Kelton J.G. Delayed-oncet heparin-induced thrombocytopenia and thrombosis. Ann Intern Med. 2001; Vol. 135: 502–6.
6. Gilorami B., Prandoni P., Stefani P.M., et al. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood. 2003; Vol. 101: 2955–9.
7. Dzemeshkevich S.L., Frolova Yu.V., Kim S.Yu., Fedorov D.N., et al. The anatomical and morphological features of diffuse - a generalized form of hypertrophic cardiomyopathy. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2015.; Vol. 5 (121): 58–63. (in Russian)
8. Linkins L.A., Dans A.L., Moores L.K., et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis. 9th ed.: American College of Chest Physicians Evidence-Based Practice Guidelines. Chest. 2012; Vol. 2: 141.