Hirudin therapy during thrombolysis for venous thrombosis in heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is the most common drug-related thro mbocytopenia. Thromboembolic complications occur in approximately 50% of pa tients with HIT and result in limb amputation and death in up to 20% and 30 % respectively. Because patients with a history of HIT may require future i ntravenous anticoagulation but have a high-risk of thromboembolism if re-ch allenged with heparin, alternative therapies are necessary when further ant icoagulation is indicated. The use of direct thrombin inhibitors in HIT pat ients who also require thrombolytic therapy offers unique challenges to ant icoagulant monitoring and safety. We present a case of progressive ileofemo ral deep venous thrombosis in a patient with a history of HIT in order to r eview the combined use of hirudin and thrombolysis in this setting.