HEPARIN-INDUCED THROMBOCYTOPENIA AND THROMBOSIS - PRESENTATION AFTER CARDIOPULMONARY BYPASS

Heparin-induced thrombocytopenia and thrombosis syndrome was diagnosed in a 63-year-old woman 11 days after coronary artery bypass grafting. Her only presenting complaints were incisional leg pain and vague che st discomfort. The syndrome was suspected when her platelet count was found to be 37,000/mu L. A subsequent ventilation-perfusion lung scan showed findings highly probable for pulmonary embolism. An inferior ve nacavogram obtained before a pulmonary angiogram revealed a large retr ohepatic thrombus at the right atrial junction. The patient was succes sfully treated with the defibrinogenating agent ancrod (Arvin). A diag nosis of heparin-induced thrombocytopenia and thrombosis syndrome shou ld be considered and heparin therapy should be avoided in patients wit h low platelet counts who have been previously treated with heparin.