A case of tongue cancer complicated by heparin-induced thrombocytopenia during perioperative management
| Autor: | Hiroshi Yamazaki, Kazunari Karakida, Kazumi Izawa, Miho Takahashi, Masashi Tamura, Nobuhito Mizusawa, Hisashi Kato, Daisuke Watanabe, Yasuhiro Nakanishi, Akihiro Kaneko |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Fistula Warfarin Inferior vena cava filter 030206 dentistry Heparin medicine.disease Inferior vena cava Argatroban Pathology and Forensic Medicine Surgery 03 medical and health sciences 0302 clinical medicine Otorhinolaryngology medicine.vein 030220 oncology & carcinogenesis Heparin-induced thrombocytopenia medicine cardiovascular diseases Oral Surgery Thrombus business medicine.drug |
| Zdroj: | Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 33:526-531 |
| ISSN: | 2212-5558 |
| DOI: | 10.1016/j.ajoms.2021.02.015 |
| Popis: | In patients with vascular diseases, heparinization is necessary for surgery. Here, we report the case of a 77-year-old man who presented with heparin-induced thrombocytopenia (HIT) during the postoperative management of tongue cancer. The patient was already on warfarin owing to arteriosclerosis obliterans, and was perioperatively administered heparin by a cardiologist. The prothrombin time-international normalized ratio (PT-INR) was stabilized, and heparin administration was terminated on postoperative day 23. However, on postoperative day 41, the PT-INR was prolonged; warfarin was discontinued, and heparin was re-administered. On day 6 after heparin re-administration (postoperative day 47), the patient developed sudden fever. Contrast-enhanced computed tomography (CT) imaging was performed to evaluate the fever and showed a thrombus at the L5 level of the inferior vena cava. Blood examination showed a platelet count of 108,000 /μL; however, the next day, the count was 87,000 /μL. On day 10 after heparin re-administration (postoperative day 51), contrast-enhanced CT imaging showed an increase in thrombus formation. Therefore, inferior vena cava filter insertion surgery was performed on day 13 of heparin re-administration (postoperative day 54). The patient was diagnosed with HIT because of thrombocytopenia and increased thrombin after the re-administration of heparin, which was discontinued on postoperative day 64; argatroban (an anti-thrombin drug) was administered for HIT treatment. The patient was discharged with an indwelling inferior vena cava filter and intestinal fistula. |
| Databáze: | OpenAIRE |
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