Klin Farmakol Farm. 2014;28(3):124-126

Acute abdominal aortic occlusion as a manifestation of heparin-induced thrombocytopenia

Jiří Holý¹, Michal Sýkora², Petr Pták³, Pavel Havránek¹

¹ Interní oddělení Nemocnice České Budějovice, a. s.

² Oddělení klinické hematologie, Nemocnice České Budějovice, a. s.

³ Chirurgické oddělení, Nemocnice České Budějovice, a. s.

Acute occlusion of the abdominal aorta is a life-threatening event with possible fatal outcomes in spite of urgent surgical management.

Heparin-induced thrombocytopenia (HIT) occurs in 1 to 3% of patients treated with heparin including low-molecular-weight heparin.

Rare type II HIT is also manifested by ischemia due to peripheral arterial thrombosis. The mainstay of therapy is termination of heparin

treatment and change of anticoagulant medication. Fondaparinux or hirudin-type anticoagulants do not cause HIT. The authors present

a case history of a 67-year-old male patient admitted to hospitalization at the department of internal medicine because of right

ileofemoral phlebothrombosis. The patient underwent rectal resection due to carcinoma two years ago and hemihepatectomy because

of metastasis 15 days before admission to the department of internal medicine. He received enoxaparin sodium preventatively in the

pre-surgical management. The patient was treated with a curative dose of nadroparin calcium. On the 6th day of hospitalization, the

patient suffered from a rapidly developing paraparesis of the lower extremities; echography showed an acute occlusion of the abdominal

aorta and probably of iliac arteries on both sides, too. Ileofemoral phlebothrombosis was found in the left lower extremity. The condition

was urgently managed by Fogarty catheter thrombectomy from both femoral arteries. Given the thrombocytopenia of 85 × 109/l and

thrombotic episodes in spite of treatment with low-molecular-weight heparin, the diagnosis of HIT was suspected and the patient was

switched to fondaparinux. The value of thrombocytes became normal during this treatment. The diagnosis of type II HIT was confirmed

by laboratory examination. This rare case report documents the possibility of comorbidity of an acutely life-threatening thrombosis of

the abdominal aorta as a consequence of type II HIT.

Keywords: acute abdominal aortic occlusion, heparin-induced thrombocytopenia, ileofemoral phlebothrombosis, fondaparinux

Published: November 1, 2014  Show citation