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The Annals of Thoracic Surgery, Vol 58, 1764-1766, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Heparin-induced thrombocytopenia and thrombosis: presentation after cardiopulmonary bypass

R Munver, IC Schulman, DJ Wolf and TK Rosengart
New York Hospital-Cornell University Medical College, New York 10021.

Heparin-induced thrombocytopenia and thrombosis syndrome was diagnosed in a 63-year-old woman 11 days after coronary artery bypass grafting. Her only presenting complaints were incisional leg pain and vague chest discomfort. The syndrome was suspected when her platelet count was found to be 37,000/microL. A subsequent ventilation-perfusion lung scan showed findings highly probable for pulmonary embolism. An inferior venacavogram obtained before a pulmonary angiogram revealed a large retrohepatic thrombus at the right atrial junction. The patient was successfully treated with the defibrinogenating agent ancrod (Arvin). A diagnosis of heparin-induced thrombocytopenia and thrombosis syndrome should be considered and heparin therapy should be avoided in patients with low platelet counts who have been previously treated with heparin.

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