Bilateral lower extremity gangrene requiring amputation associated with heparin-induced thrombocytopenia--a case report

• Published in: Vascular and endovascular surgery Vol. 40; no. 2; p. 161
• Main Authors: Dickinson, Brian P, De Ugarte, Daniel A, Reil, Todd D, Beseth, Bryce D, Lawrence, Peter F
• Format: Journal Article
• Language: English
• Published: United States 01.03.2006
• Subjects: Aged; Amputation; Antibodies - blood; Anticoagulants - adverse effects; Gangrene - blood; Gangrene - etiology; Gangrene - surgery; Heparin - adverse effects; Heparin - immunology; Humans; Ischemia - blood; Ischemia - etiology; Ischemia - surgery; Knee - surgery; Lower Extremity - blood supply; Lower Extremity - surgery; Male; Thrombocytopenia - blood; Thrombocytopenia - etiology; Thrombosis - blood; Thrombosis - etiology; Thrombosis - surgery
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/153857440604000212

Heparin use, both prophylactically and therapeutically, is prevalent among hospitalized patients. Patients on heparin may develop a thrombocytopenia that is self-limited. Fewer patients develop a heparin-induced thrombocytopenia that can cause severe bleeding and thrombosis owing to intravascular platelet aggregation. The authors present a case report of heparin-induced thrombocytopenia in a patient who underwent aortic arch and aortic valve replacement that resulted in bilateral above-knee amputations. The patient developed limb ischemia related to heparin-associated thrombosis, but had a delay in antibody seroconversion. Early and accurate diagnosis of heparin-induced thrombocytopenia requires a high clinical suspicion and may be present despite the absence of serum antibodies.