Idiopathic catastrophic thrombosis with happy ending.

Abstract

A 59-year-old male patient suffered three life-threatening instent thromboses after an initial resuscitation due to an ST-segment elevation myocardial infarction of the anterior cardiac wall. With a high-risk profile for heparin-induced thrombocytopenia (HIT), he was placed on argatroban after the second reinfarction. Under this apparently appropriate treatment, a third reinfarction occurred, and the patient had to undergo high-risk cardiac bypass surgery. Later on, a deep vein thrombosis and an intracardiac thrombus formed. Despite a positive screening test for HIT and a single positive result in the heparin-induced platelet aggregation test, we are not convinced that HIT was the only underlying cause for this 'catastrophic thrombotic syndrome'. We speculate that a massive generation of thrombin, reflected in consistently high D dimers and the need of copious amounts of a direct thrombin inhibitor, triggered the set of events. With this case report, we want to raise awareness for cardiac complications in patients with complex clotting disorders and share our experience in the diagnostic and therapeutic management of such an unusual scenario.

• Authors: Julia Heid, Andreas Greinacher, Hugo A Katus, Oliver J Müller
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2017 (Oct 23 2017) ISSN: 1757-790X [Electronic] England
• PMID: 29066639 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Anticoagulants
• Antithrombins
• Pipecolic Acids
• Platelet Aggregation Inhibitors
• Sulfonamides
• Heparin
• Arginine
• argatroban
• Phenprocoumon

Topics

• Anticoagulants (adverse effects, therapeutic use)
• Antithrombins (therapeutic use)
• Arginine (analogs & derivatives)
• Awareness
• Blood Coagulation Tests (methods)
• Coronary Artery Bypass (methods)
• Heparin (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Phenprocoumon (administration & dosage, therapeutic use)
• Pipecolic Acids (administration & dosage, therapeutic use)
• Platelet Aggregation Inhibitors (therapeutic use)
• ST Elevation Myocardial Infarction (complications, diagnosis, surgery)
• Sulfonamides
• Thrombocytopenia (chemically induced, diagnosis)
• Thrombosis (etiology)
• Treatment Outcome
• Ultrasonography (methods)
• Venous Thrombosis (diagnostic imaging)