HEPARIN-ASSOCIATED THROMBOCYTOPENIA OF TY PE-II AS A CAUSE OF MULTIPLE THROMBOEMBOLIC COMPLICATIONS

13 days after hysterectomy and subcutaneous treatment with unfractiona ted heparin (10 000 IU daily) a 68 year old women developed a pulmonar y embolism and deep vein thrombosis of the right leg. She therupon rec eived intravenous heparin (1000 IU/h). Eight days later she developed acute ischaemia of both legs, and Doppler examination revealed acute L eriche's Syndrome with thrombosis of both iliac arterys. Platelet coun t fell from, initially 152 x 10(9)/1, to 44 x 10(9)/1. Although hepari n-associated thrombocytopenia type II was suspected a confirmation by demonstrating a heparin dependent antibody with the heparin-induced pl atelet activation (HIPA)-test failed and therefore crossreactivity of low molecular heparins or heparinoids could not be assessed. After dis continuation of heparin and iliacal artery thrombectomy a combination therapy with aspirin plus ticlopidine (500 mg/d respectively) was star ted and continued until phenprocoumon could exert its full effect. No recurrent thromboembolic events occured, the platelet counts normalize d and the patient fully recovered.