Refractory Heparin-Induced Thrombocytopenia in a Patient With Subarachnoid Hemorrhage-A Clinical Conundrum.
Faith NewtonKimberly GlaserJennifer ReevesLyndsay SheperdBappaditya RayPublished in: The Neurohospitalist (2021)
Heparin induced thrombocytopenia (HIT) often resolves with discontinuation of heparin/ heparinoid products. Severe HIT with platelet counts <20,000/µL and disseminated intravascular coagulation is frequently associated with consumptive coagulopathy and systemic thrombosis. Management of severe HIT in patients who fail to improve on discontinuing heparinoid products and argatroban infusion is not well established. We describe a patient admitted with aneurysmal subarachnoid hemorrhage (SAH) who developed severe autoimmune HIT, failed conventional anticoagulation therapy with argatroban and progressed to develop extensive deep venous thrombosis and limb ischemia. She was successfully treated using bivalirudin, immunomodulation with 2 cycles of intravenous immunoglobulin and immunosuppression with methylprednisolone. Refractory severe HIT among SAH patients is rare and pose several therapeutic challenges. We report successful treatment using alternate anticoagulant and immune suppression and modulation.
Keyphrases
- venous thromboembolism
- subarachnoid hemorrhage
- drug induced
- early onset
- brain injury
- atrial fibrillation
- high glucose
- end stage renal disease
- high dose
- diabetic rats
- growth factor
- ejection fraction
- low dose
- multiple sclerosis
- stem cells
- oxidative stress
- cerebral ischemia
- pulmonary embolism
- peritoneal dialysis
- bone marrow
- coronary artery disease
- endothelial cells