Low molecular weight heparin-induced thrombocytopenia management during hemodialysis and cardiac surgery: a case report and literature review

• Published in: JA clinical reports Vol. 11; no. 1; pp. 18 - 5
• Main Authors: Takada, Shuto, Suzuki, Shogo, Tamura, Takahiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 28.03.2025; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Antibodies; Anticoagulants; Blood clots; Blood platelets; Case Report; Case reports; Critical Care Medicine; Dalteparin; Emergency Medicine; Flow velocity; Heart surgery; Hemodialysis; Heparin-induced thrombocytopenia; Intensive; Intensive care; Kidney diseases; Literature reviews; Low molecular weight heparin; Medical Subject Headings-MeSH; Medicine; Medicine & Public Health; Molecular weight; Pain Medicine; Thrombocytopenia; Thrombosis; Dalteparin; Low molecular weight heparin; Heparin-induced thrombocytopenia
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-025-00781-0

Background Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, including low molecular weight heparins (LMWHs) like dalteparin. While LMWHs reduces the risk of HIT compared to unfractionated heparin, vigilance remains essential. Case presentation An 82-year-old male with chronic kidney disease (CKD) developed HIT during hemodialysis anticoagulation with dalteparin, resulting in a platelet count of 17,000/µL and positive HIT antibodies. Dalteparin was replaced with nafamostat mesilate. Following confirmed HIT antibody seronegativity, elective aortic valve replacement was performed under cardiopulmonary bypass using heparin. Postoperative dialysis was managed using nafamostat mesilate, preventing HIT recurrence. His platelet count recovered after dalteparin replacement, and no recurrence of HIT was observed. Conclusions Even LMWHs, such as dalteparin, pose a HIT risk, necessitating vigilant monitoring. Confirming HIT antibody seronegativity and appropriately timing surgery are critical for patients with a history of HIT. Proper postoperative follow-up and alternative anticoagulation strategies can prevent HIT recurrence.