Heparin-induced thrombocytopenia: rapid correction of the trombocytopenia and improvement after plasma exchange

Introduction. - Heparin-induced thrombocytopenia with thrombosis is a rare but severe adverse reaction to heparin therapy, whose management is difficu lt. After heparin withdrawal, the initiation of an alternative anticoagulan t therapy, such as recombinant hirudin or danaparoid, is strongly recommend ed before vitamine K antagonists are effective. Several reports of the effi cacity of plasma exchanges in patients with life-threatening thrombosis hav e been made. Exegesis. - We report on a patient with severe aortic thrombosis related to heparin therapy in whom a unique plasma exchange resulted in both dramatic improvement in the platelet count and marked reduction of the thrombosis. Conclusion. - This case provides further evidence that plasma exchanges can be useful in the management of heparin-induced thrombocytopenia with throm bosis. They are rapidly efficient and can be used before heparin alternativ e treatment is effective. (C) 1998 Elsevier, Paris.