refludan and Thrombophlebitis

Topics: Adolescent; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Antithrombins; beta 2-Glycoprotein I; Diagnosis, Differential; Disease Progression; Dose-Response Relationship, Drug; Down Syndrome; Enoxaparin; Female; Hirudins; Humans; Immunoglobulin M; Recombinant Proteins; Renal Veins; Thrombophlebitis; Thrombosis; Vena Cava, Inferior

Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.

Topics: Adult; Aged; Amputation, Surgical; Anticoagulants; Aorta; Aortic Aneurysm; Aortic Dissection; Aortic Valve; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Coronary Artery Bypass; Early Diagnosis; Fibrinolytic Agents; Heart Valve Prosthesis Implantation; Heparin; Hirudins; Humans; Intra-Aortic Balloon Pumping; Ischemia; Leg; Male; Marfan Syndrome; Mitral Valve; Postoperative Complications; Recombinant Proteins; Thrombocytopenia; Thrombophlebitis

We report two patients with deep-vein thrombosis complicating immune heparin-induced thrombocytopenia who developed venous limb gangrene during overlapping therapy with a direct thrombin inhibitor (lepirudin or argatroban) and warfarin. In both patients, therapy with the direct thrombin inhibitor was interrupted during persisting severe athrombocytopenia while warfarin administration continued. Both patients exhibited the typical feature of a supratherapeutic international normalized ratio (INRs, 5.9 and 7.3) that has been linked previously with warfarin-associated venous limb gangrene. These data suggest that warfarin anticoagulation be postponed in patients with acute heparin-induced thrombocytopenia until substantial recovery of the platelet count has occurred.

Topics: Aged; Aged, 80 and over; Amputation, Surgical; Anticoagulants; Arginine; Autoimmune Diseases; Catheterization, Central Venous; Contraindications; Drug Administration Schedule; Drug Therapy, Combination; Female; Gangrene; Heparin; Hirudin Therapy; Hirudins; Humans; International Normalized Ratio; Leg; Male; Middle Aged; Necrosis; Pipecolic Acids; Protein C Deficiency; Recombinant Proteins; Sulfonamides; Surgical Wound Infection; Thrombin; Thrombocytopenia; Thrombophlebitis; Warfarin

Topics: Anticoagulants; Coumarins; Female; Fibrinolytic Agents; Heparin; Hirudin Therapy; Hirudins; Humans; Middle Aged; Phenprocoumon; Pulmonary Embolism; Recombinant Proteins; Thrombocytopenia; Thrombophlebitis; Time Factors

Topics: Anticoagulants; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Fibrinolytic Agents; Heparin; Heparitin Sulfate; Hirudin Therapy; Hirudins; Humans; Recombinant Proteins; Thrombocytopenia; Thrombophlebitis