[Heparin-induced Thrombocytopenia after Total Arch Replacement]

Area of Science:

• Cardiovascular Surgery
• Hematology
• Neurology

Background:

• A 71-year-old male underwent total aortic arch replacement for a true aortic arch aneurysm.
• Postoperatively, the patient developed neurological deficits including right hemiplegia and motor aphasia.

Observation:

• Cerebral infarction was identified via CT and MRI scans on postoperative day 10.
• A significant decline in platelet count was observed from postoperative day 15, raising suspicion for heparin-induced thrombocytopenia.

Findings:

• Heparin administration was ceased, and treatment with argatroban and warfarin was initiated.
• Blood tests confirmed heparin-induced thrombocytopenia with elevated anti-platelet factor 4 (PF4)/heparin antibodies and specific IgG.
• Functional assays of platelet-derived microparticles showed a pattern consistent with heparin-induced thrombocytopenia.

Implications:

• Early diagnosis and cessation of heparin are crucial for managing heparin-induced thrombocytopenia.
• Alternative anticoagulants like argatroban are effective in preventing further thromboembolic events.
• This case highlights the importance of monitoring platelet counts and considering heparin-induced thrombocytopenia in patients with unexplained thrombosis post-heparin exposure.