A case of heparin induced thrombocytopenia treated with fondaparinux

Key Findings & Data:A 48 year-old male patient was referred to our clinic when bilateral main pulmonary arterial thromboses were detected by spiral computerized tomography after he sought consultation for chest pain, dyspnea and presyncope of 3 days duration.

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Conclusion & Impact:Oral anticoagulant therapy was started when the thrombocyt count reached >100000/mm3 on the sixth day of treatment.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:İlaç toksisitesi · Heparin · Trombositopeni

Abstract

Heparin induced thrombocytopenia (HIT) is an important complication of heparin treatment. In this article, we presented a case of HIT who was treated with fondaparinux, which is the only alternative anticoagulant agent in our country. A 48 year-old male patient was referred to our clinic when bilateral main pulmonary arterial thromboses were detected by spiral computerized tomography after he sought consultation for chest pain, dyspnea and presyncope of 3 days duration. In the physical examination, tachypnea, tachycardia, cyanosis, hypotension, neck vein distention, hepatomegaly and hepatojugular reflux were recorded. After the diagnosis of massive PTE, unfractionated heparin (UFH) infusion was started following the treatment with r-tPA. UFH was stopped due to the rapid fall in thrombocyte count (39000/mm3) on the second. day of treatment. PF4-heparin antibodies detected by ELİSA were positive. Anticogulant therapy was followed with fondaparinux. Oral anticoagulant therapy was started when the thrombocyt count reached >100000/mm3 on the sixth day of treatment.

Özet

Heparine bağlı trombositopeni (HİT), heparin tedavisinin önemli bir komplikasyonudur. Bu yazıda, ülkemizde tek alternatif antikoagulan ilaç olan fondaparinux ile tedavi edilen HİT olgusu sunulmuştur. Kırk sekiz yaşında erkek hasta, 3 gündür olan göğüs ağrısı, nefes darlığı ve fenalaşma şikayetleri ile başvurduğu hastanede çekilen spiral toraks bilgisayarlı tomografide; her iki ana pulmoner arteri tıkayan trombüs izlenmesi üzerine kliniğimize sevk edildi. Fizik muayenesinde, taşipne, taşikardi, siyanoz, hipotansiyon, boyun venlerinde dolgunluk, hepatomegali ve hepatojuguler reflü saptandı. Masif pulmoner emboli tanısı konularak r-tPA uygulandıktan sonra klasik heparin (KH) infüzyonu ile tedaviye devam edildi. Trombosit sayısı 2. günde 39000/mm3'e düşünce KH kesildi. ELİSA yöntemiyle bakılan PF4-trombosit antikorları pozitif saptandı. Antikoagulan tedaviye fondaparinux ile devam edildi. Bu tedavinin 6. gününde trombosit sayısı >100000/mm3 olunca oral antikoagulan tedavi başlandı.

Keywords

İlaç toksisitesi Heparin Trombositopeni Pulmoner emboli Erkek Orta yaşlı Drug Toxicity Thrombocytopenia Pulmonary Embolism Male Middle Aged

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Cite This Article

ALPAY, N., OKUMUŞ, G., KIYAN, E., KÜÇÜKKAYA, R. D., TABAK, L., ECE, T., ARSEVEN, O. (2009). A case of heparin induced thrombocytopenia treated with fondaparinux. Türk Toraks Dergisi, Cilt: 10 - Sayı: 4, 193–195. https://ajindex.com/articles/329579

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