Ostalo
Treatment of venous thromboembolism with argatroban in a patient who developed HIT II – case report
Višnjica Suvić-Križanić
; Department of Internal Medicine, General Hospital ’Ivo Pedišić’, Sisak, Croatia
Meri Prinčić
; Department of Transfusion Medicine, General Hospital ’Ivo Pedišić’, Sisak, Croatia
Marija Ruševljan
; Department of Transfusion Medicine, General Hospital ’Ivo Pedišić’, Sisak, Croatia
Maja Tomičić
; Department of Platelet and Leukocyte Diagnosis and Haemostasis, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
Željka Hundrić-Hašpl
; Croatian Institute of Transfusion Medicine, Zagreb, Croatia
Sažetak
Representing this patient our intention was to stress the importance of monitoring platelet number in patient on heparin therapy. We have, for the first time, in our hospital used reversibile thrombine inhibitor, that showed efficacy in treatening HIT II complications. HIT II immunologicaly caused side-effect of heparin therapy, characterized by decrease in thrombocyte number for more than 50 %, with increased inclination to thromboembolic incidents. The disease most commonly appears 5-10 days after initiation of mainly unfractionated heparin therapy. Application of ’4 T score’ in clinical judgement for HIT probability, and laboratory investigation for presence of anti-heparin antibodies markedly contribute to in time detection and treatment of this illness. If anti-heparin antibodies are detected, heparin application must be stopped immidiately, and must be replaced by some anti-heparin anticoagulant preparation ( Fxa inhibitor, heparinoide, or direct inhibitor of thrombine). In time application of substitutional preparation for heparin markedly diminishes the occurence of thromboembolic complications.
We presented the case of patient hospitalized in our institution by reason of complete thrombosis of left illiac vein, joint femoral vein, deep veins of femoral region, popliteal vein and initial part of great saphenous vein. Treatment started by non-fractionated heparin and continued by warfarin, but the patient developed clinical feature of HIT II, so, current anticoagulant therapy was stopped , and fondaparinux was introduced. Although thrombocyte number increased, D-dimers were in additional rise, and patient developed pulmonary embolism. Reversible thrombin inhibitor argatroban was introduced in therapy in daily dose of 2 μg/kg/min in continual infusion lasting 15 days, followed by continual APTT monitoring,in therapeutic range 1.5-2 times of basic value. Rise in platelet number was monitored, decrease of D-dimer, and local clinical improvement. Marginal recanalization of veins in left femoral region and complete passage of popliteal vein were documented by color doppler.
Further, clinical estimation of HIT II probability using „4T“ graduating system, and laboratory investigation to antiheparin antibodies, had significant role in diagnosis confirmation, and in selecting suitable substitutional preparation for heparin.
Ključne riječi
thrombocytopenia; heparin; deep veins thrombosis (DVT); pulmonary embolism (PE); heparin induced thrombocytopenia type II (HIT II); heparin antibodies; fondaparinux; argatroban
Hrčak ID:
275976
URI
Datum izdavanja:
25.11.2012.
Posjeta: 409 *