THROMBOLYSIS TO TREAT ARTERIAL THROMBOTIC COMPLICATIONS OF HEPARIN-INDUCED THROMBOCYTOPENIA

An 80-year-old man with diabetes developed acute ischemia of the right leg secondary to heparin-induced thrombocytopenia while being treated for a pulmonary embolism. For fear of recurrent thrombosis at the ope rative site, he was treated with cessation of heparin, placement of a Greenfield filter, and intra-arterial infusion of urokinase into the p opliteal artery for 36 hours. All arterial thrombus resolved with no c omplications. One week later he underwent a below-knee popliteal to an terior tibial artery translocated cephalic vein bypass and transmetata rsal amputation for progressive gangrene of the right toes. The graft remains patent 2 years later. This patient represents the eighth case reported in the world literature in which thrombolytic therapy was use d to treat arterial thrombotic complications of heparin-induced thromb ocytopenia. Five patients were successfully treated without complicati ons, two others required major amputations, and one died of adrenal he morrhage. Although thrombolytic therapy should be used cautiously for treatment of arterial thrombotic complications of heparin-induced thro mbocytopenia, this adjunct may prove useful and safe in selected cases .