Heparin-Induced Thrombocytopenia: A Spectrum of Hemorrhage and Thrombosis—Case Presentations

Abstract

Three cases of the heparin-induced thrombocytopenia syndrome are presented. Two of the patients died of thrombotic sequelae and 1 patient survived but suffered a significant bleeding complication. Several significant features are identified: (1) clinical presentation of the syndrome was apparent just before a fall in the platelet count; (2) platelet counts below 100,000/mm3 were not necessary for complications to occur; (3) antiplatelet IgM antibody was identified with the bleeding complication, as opposed to IgG in the thrombotic complication ; (4) despite cessation of heparin and institution of coumadin in 1 patient, platelet counts remained depressed and thrombotic complications continued to occur; and (5) superior vena cava thrombosis occurred in 1 patient, a condition previously unreported. These findings offer a means of suspecting the diagnosis before complications occur, raise questions regarding mechanism and management of the disorder, and add to the spectrum of thrombohemorrhagic sequelae associated with this syndrome.