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  • Title: [Thrombocytopenia associated with massive cardiac thrombosis during treatment with non-fractionated heparin: description of a clinical case].
    Author: De Piccoli B, Martino A, Zuin G, Raviele A.
    Journal: Ital Heart J Suppl; 2002 Aug; 3(8):869-73. PubMed ID: 12407843.
    Abstract:
    Thrombosis associated with a drop in the platelet count may occur in 33-50% of the patients who develop heparin-induced thrombocytopenia (HIT) during treatment with unfractionated heparin; the deep veins are commonly involved while cardiac thrombosis is considered as a rare complication. We report the case of a 64-year-old woman who was treated with unfractionated heparin following a myocardial infarction and an episode of deep vein thrombosis which occurred 13 days after myocardial revascularization including triple coronary artery bypass grafting; a drop in the patient's platelet count was documented and a transesophageal echocardiogram revealed massive thrombosis of the four cavities of her heart. The diagnosis of HIT was supported by high blood levels of PF4-antiheparin antibodies. Heparin infusion was stopped and the patient was started on sodium warfarin therapy; the platelet count promptly returned to normal and the size of the clots slowly decreased, although they were still detectable 1 month later. Aspirin (325 mg daily) was then prescribed as an adjunct to warfarin and 6 months later we documented the total disappearance of the thrombotic masses without embolic complications.
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