Multiple cardiac thrombi and thromboembolism in a heparin-induced thrombocytopenia antibody–positive patient with heart failure

• Published in: The American journal of emergency medicine Vol. 26; no. 9; pp. 1066.e5 - 1066.e7
• Main Authors: Wake, Ryotaro, MD, PhD, Muro, Takashi, MD, PhD, Hozumi, Takeshi, MD, PhD, Matsumoto, Ryo, MD, PhD, Kataoka, Toru, MD, PhD, Nakamura, Yasuhiro, MD, PhD, Takemoto, Yasuhiko, MD, PhD, Takagi, Masahiko, MD, PhD, Suehiro, Shigefumi, MD, PhD, Yoshiyama, Minoru, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2008; Elsevier Limited
• Subjects: Anticoagulants - adverse effects; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Coronary Artery Bypass; Coronary Artery Disease - complications; Coronary Artery Disease - surgery; Drug therapy; Electrocardiography; Emergency; Emergency medical care; Heart failure; Heart Failure - complications; Heparin - adverse effects; Humans; Male; Middle Aged; Thrombectomy; Thrombocytopenia - complications; Thromboembolism; Thromboembolism - complications; Thromboembolism - surgery
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.03.018

A 49-year-old Japanese man presented with orthopnea and edema in both legs. He was diagnosed with congestive heart failure with triple-vessel coronary artery disease. Low antithrombin and left ventricular systolic dysfunction were possible causes of his hypercoagulable state. Echocardiography revealed thrombi in the left ventricle and left trium, poor left ventricular contractility, and a normal mitral valve. Electrocardiogram revealed normal sinus rhythm. We found small infarctions of the brain and spleen in the computed tomography. The heparin treatment of cardiac thrombi is useless because the patient had heparin-induced thrombocytopenia antibody. We removed thrombi in the left ventricle and left atrium by thrombectomy and performed coronary artery bypass graft. Warfarin was administered for anticoagulation. He recovered completely and is now doing well. Our experience indicates that poor cardiac function can together cause multiple cardiac thrombi and subsequent thromboembolism without mitral stenosis or atrial fibrillation.