Japanese Journal of Cardiovascular Surgery Vol47,No3

Delayed-Onset Heparin-Induced Thrombocytopenia Following Aortic Valve Replacement
Yasuo Kondo* Noriyuki Takashima* Tomoaki Suzuki**
Tohru Asai**

(Division of Cardiovascular Surgery, Koto Memorial Hospital*, Higashiomi, Japan, and Division of Cardiovascular Surgery, Shiga University of Medical Science**, Otsu, Japan)

Some 50% of patients who undergo cardiac surgery will have heparin-induced thrombocytopenia(HIT)antibodies, only 1% will develop typical clinical HIT. Especially delayed-onset HIT is not well-known and extremely rare. A 83-year-old man underwent aortic valve replacement(AVR)with a bioprosthetic valve(Mitroflow 21mm)and pulmonary vein isolation(PVI). Intravenous unfractionated heparin(8,000I.U./day)was administered for 5 days after surgery. He had a good recovery and was discharged to home with a platelet count of 100,600/μl on POD 15 on warfarin. On POD 18, he was readmitted to our hospital due to cerebral infarction with hemiparesis. As MRI revealed a multiple left hemispheric infarction, the presence of cardiogenic cerebral infarction was suspected. Continuous intravenous administration of unfractionated heparin(15,000I.U./day)was started. On POD 24, the platelet count fell to 27,000/μl, and a contrast CT scan revealed a giant thrombus in the aortic arch. He was found to have HIT antibodies, supporting a diagnosis of HIT. After cessation of heparin therapy and administration of vitamin K antagonist, argatroban was administered. He recovered neurologically and was discharged on POD 58. He remains well at 3 years follow up. If a patient has an unexplained and severe thrombocytopenia after cardiovascular surgery, delayed-onset HIT should be taken into consideration.


Jpn. J. Cardiovasc. Surg. 47:113-117(2018)


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