An impetuous "HIT"-sudden blockage of all grafts post CABG

Area of Science:

• Cardiology
• Hematology
• Immunology

Background:

• Coronary artery bypass graft (CABG) surgery is a common procedure.
• Immune thrombocytopenia (ITP) is a chronic autoimmune disorder.
• Heparin-induced thrombocytopenia (HIT) is a serious immune complication of heparin therapy.

Observation:

• A 69-year-old female with chronic ITP developed hyperacute multiple graft thrombosis post-CABG.
• Evaluation revealed anti-PF4/heparin antibodies, confirming HIT.
• The co-existing ITP masked typical HIT thrombocytopenia, delaying diagnosis.

Findings:

• The presence of anti-PF4/heparin antibodies confirmed HIT.
• Chronic ITP complicated the clinical presentation and diagnosis of HIT.
• Hyperacute graft thrombosis was the primary thrombotic event.

Implications:

• Discontinuing heparin promptly upon suspicion or confirmation of HIT is critical.
• A low threshold for suspecting HIT in ITP patients undergoing cardiac surgery is essential.
• This complex interplay increases the risk of severe postoperative complications.