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Native aortic valve thrombosis due to heparin-induced thrombocytopenia

Yu Inaba1, Yasunori Iida2, Hidetoshi Oka2

  • 1Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Yokohama, Kanagawa, 230-8765, Japan. yuys4223@gmail.com.

General Thoracic and Cardiovascular Surgery
|November 26, 2021
PubMed

Insights

A patient undergoing coronary artery bypass grafting (CABG) likely had undiagnosed heparin-induced thrombocytopenia (HIT), a serious complication causing low platelets, which complicated his surgery.

Area of Science:

  • Cardiology
  • Hematology
  • Vascular Surgery

Background:

  • A 65-year-old male presented with unstable angina requiring coronary artery bypass grafting (CABG).
  • Preoperative imaging revealed a significant thrombus within the left coronary cusp (LCC).

Observation:

  • The patient underwent CABG with concomitant thrombectomy under cardiopulmonary bypass utilizing unfractionated heparin.
  • Despite a large thrombus in the LCC, the left coronary artery ostium remained unobstructed.
  • A precipitous drop in platelet count (68% decrease) was noted 12 days after initiating heparin therapy at a prior facility.

Findings:

  • The clinical presentation and laboratory findings strongly suggest a diagnosis of heparin-induced thrombocytopenia (HIT).
  • The unrecognized HIT likely contributed to the complex surgical scenario and thrombotic event.

Implications:

  • This case highlights the critical importance of recognizing and managing heparin-induced thrombocytopenia (HIT) in patients undergoing cardiac surgery.
  • Prompt diagnosis and alternative anticoagulation strategies are essential to prevent severe complications in HIT patients.
  • Enhanced preoperative screening for HIT may improve surgical outcomes in at-risk populations.

Keywords:
Aortic valveCABGHeparin-induced thrombocytopeniaThrombosis

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