Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review.

Autor: Nekooghadam SM; Department of Internal Medicine School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran., Ebrahimi-Dehkordi S; Student Research Committee Shahrekord University of Medical Sciences Shahrekord Iran., Paraandavaji E; Skull Base Research Center Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran., Pishgahi M; Department of Cardiology School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran., Ghadirzadeh E; Cardiovascular Research Center Mazandaran University of Medical Sciences Sari Iran., Charkazi E; Semnan University of Medical Sciences Semnan Iran., Ghorbani P; Cardiovascular Research Center Mazandaran University of Medical Sciences Sari Iran.
Jazyk: angličtina
Zdroj: Clinical case reports [Clin Case Rep] 2023 Aug 21; Vol. 11 (8), pp. e7839. Date of Electronic Publication: 2023 Aug 21 (Print Publication: 2023).
DOI: 10.1002/ccr3.7839
Abstrakt: The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low-molecular-weight heparin. Heparin-induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6-week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy-related HIT. HIT is a pro-coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.
Competing Interests: The authors have no conflict of interest to declare.
(© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje