Postendarterectomy heparin-induced thrombocytopenia. Case report

Area of Science:

• Vascular Surgery
• Hematology
• Pharmacology

Background:

• Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries.
• Anticoagulation therapy with heparin is often used perioperatively in vascular surgery.
• Heparin is a common anticoagulant, but can have adverse effects.

Observation:

• A patient experienced two episodes of massive bleeding from a sutured arteriotomy within 30 hours post-carotid endarterectomy.
• The patient had received 72 hours of heparin anticoagulation prior to the surgery.
• A significant drop in platelet count (thrombocytopenia) was noted after the second bleeding event.

Findings:

• The observed bleeding and thrombocytopenia suggest a potential diagnosis of heparin-induced thrombocytopenia.
• Drug-induced thrombocytopenia is a serious complication that can arise from heparin use.
• Low platelet counts can compromise surgical site hemostasis.

Implications:

• Vascular surgeons and hematologists should consider drug-induced thrombocytopenia in patients with bleeding post-heparin therapy.
• Early recognition and management of thrombocytopenia are crucial to prevent further complications.
• This case highlights the importance of monitoring platelet counts in patients receiving heparin during the perioperative period for vascular procedures.