Delayed-onset heparin-induced thrombocytopenia

Ann Emerg Med. 2005 Apr;45(4):417-9. doi: 10.1016/j.annemergmed.2004.08.005.

Abstract

Delayed-onset heparin-induced thrombocytopenia is a syndrome in which thrombocytopenia and thrombosis begin several days after heparin discontinuation. Delayed-onset heparin-induced thrombocytopenia is caused by immunoglobulin G antibodies that are reactive against the heparin-platelet factor 4 complex in the absence of circulating heparin. We describe 2 patients with delayed-onset heparin-induced thrombocytopenia who presented to the emergency department. An 88-year-old man and a 62-year-old man experienced thrombocytopenia and thrombosis 9 or more days after heparin cessation and demonstrated a further decrease in platelet count on reexposure to heparin. Delayed-onset heparin-induced thrombocytopenia should be included in the differential diagnosis of a patient with recent heparin exposure who presents with thrombosis or thrombocytopenia.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use
  • Emergency Service, Hospital
  • Heparin / adverse effects*
  • Heparin / immunology
  • Hirudins / analogs & derivatives*
  • Humans
  • Male
  • Middle Aged
  • Platelet Factor 4 / immunology
  • Recombinant Proteins / therapeutic use
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / immunology
  • Time Factors
  • Venous Thrombosis / chemically induced
  • Venous Thrombosis / drug therapy

Substances

  • Anticoagulants
  • Hirudins
  • Recombinant Proteins
  • Platelet Factor 4
  • Heparin
  • lepirudin