A Case of Heparin-induced Thrombocytopenia with Thromboembolism after Esophagectomy

Abstract

A 78-year-old man who had previous history of cerebral infarction and had been on oral antiplatelet regimen underwent operation for esophageal cancer. Before the operation, we substituted heparin for the antiplatelet drug. When heparin administration was resumed postoperatively, the platelet level abruptly dropped to 3.5 × 10⁴/μL and heparin-induced thrombocytopenia (HIT) was suspected. After we substituted argatroban hydrate for heparin, the dropped serum platelet level was gradually normalized. Thereafter he developed deep vein thrombosis (DVT) and pulmonary thromboembolism, for that an inferior vena cave filter was placed. After we confirmed the disappearance of DVT, argatroban hydrate was changed to edoxaban tosilate hydrate and the IVC filter was removed.

Although HIT is a rare disease, it can be associated with thromboembolism and is potentially lethal without giving appropriate therapies. Early diagnosis and treatment are mandatory. Attention should be paid to the disease when we use heparin.