Local application of heparin ointment as a trigger factor for the heparin-induced thrombocytopenia

Abstract

Heparin-induced thrombocytopenia (GIT) is a paradoxical reaction of platelets to heparin (their aggregation and destruction), potentially dangerous by the development of venous and arterial thrombosis, less often bleeding. There are serious problems of timely diagnosis of this complication. They are due to both insufficient awareness of specialists and the presence of a negative psychological attitude. The article presents a clinical case of treatment of a 57-year-old patient who was prescribed local application of heparin ointment for catheter thrombosis of the superficial veins of the left upper limb. After 8 days, the patient developed a clinical and instrumental picture of occlusive thrombosis of the right brachial vein. The patient was prescribed enoxaparin 0.6 x 2 times a day subcutaneously. After 4 days since the appointment of enoxaparin, a sharp deterioration in the patient’s condition: lower paraplegia with impaired pelvic organ function developed. There was a decrease in platelet levels by more than 2 times to 49x109/l. The probability of developing GIT on the «4T» scale is 8 points (high probability of GIT). Despite the treatment, the patient’s condition progressively worsened with the development of thrombosis of the infrarenal aorta, both common iliac arteries, massive trunk thromboembolism, segmental and subsegmental branches of the left pulmonary artery, intracerebral hemorrhage with a breakthrough into the ventricular system. Conclusion: heparin-induced thrombocytopenia, a rare but extremely dangerous complication observed in patients receiving heparin. The key to preventing the catastrophic consequences of GIT is awareness, alertness of clinicians and the use of modern algorithms for the diagnosis and treatment of GIT.