"Keep HIT in Mind and Take Care". Multiple Tips From a Single Patient

Area of Science:

• Cardiology
• Hematology
• Vascular Surgery

Background:

• Heparin-induced thrombocytopenia (HIT) presents significant mortality risks, especially post-cardiac surgery.
• Warfarin use after valvular surgery is common but dangerous during active HIT.
• Danaparoid is effective against HIT but its half-life complicates post-operative use.

Observation:

• A patient developed HIT six days post-cardiac surgery, initially misdiagnosed as endocarditis.
• Warfarin was initiated but stopped due to bleeding risk from thrombocytopenia.
• Redo surgery revealed a left atrial thrombus; bivalirudin and danaparoid were used postoperatively.

Findings:

• HIT diagnosis was delayed due to a concurrent misleading diagnosis.
• Alternative anticoagulants, bivalirudin and danaparoid, were successfully employed post-HIT diagnosis.
• Management required adapting anticoagulation to the patient's recent surgical status.

Implications:

• Maintain high suspicion for HIT in cardiac surgery patients, even with other plausible causes of thrombocytopenia.
• Unrecognized HIT can lead to severe consequences if warfarin is discontinued without alternative anticoagulation.
• Tailored anticoagulant strategies are essential for managing HIT in the complex post-cardiac surgery setting.