Lower limb gangrene postcardiac surgery

Area of Science:

• Vascular Surgery
• Hematology
• Pharmacology

Background:

• A 67-year-old male with a history of coronary artery bypass graft developed acute left foot pain.
• The patient had recently received intravenous heparin, a common anticoagulant medication.

Observation:

• Examination revealed black-purple discoloration and pitting edema of the left foot digits.
• New-onset thrombocytopenia and deep vein thrombosis were detected via ultrasound.
• Pulses in the posterior tibial and dorsalis pedis arteries remained patent.

Findings:

• The clinical presentation and history were consistent with heparin-induced thrombocytopenia (HIT).
• Venous gangrene secondary to deep vein thrombosis was the primary complication.
• HIT was diagnosed based on recent heparin exposure, thrombocytopenia, and thrombosis.

Implications:

• Early recognition and management of HIT are critical to prevent limb loss.
• Treatment involved switching to alternative anticoagulants, including danaparoid and warfarin.
• Complete resolution of venous gangrene was observed within one month of treatment initiation.