遊離皮弁術後にへパリン起因性血小板減少症 (heparin-induced thrombocytopenia : HIT) による内頸静脈と外頸静脈の完全閉塞を生じた1例

抄録

A 57-year-old man underwent reconstruction with a forearm flap after removal of tongue cancer. The patient was given 5,000 units/day of heparin for anticoagulation of anastomosis. Platelet count decreased markedly to 34,000/μl on postoperative day 6, and flap color turned dark red, necessitating emergent surgery. Total thrombosis of the internal and external jugular veins was confirmed. Heparin-induced thrombocytopenia (HIT) was suspected, and all heparin administration including flush solutions of pressure monitoring lines was discontinued. The anti-platelet factor 4/heparin antibody test was carried out and the patient was treated with another anticoagulant regimen with the use of argatroban. On postoperative day 12, the anti-platelet factor 4/heparin antibody test was found positive, and the definitive diagnosis was HIT. The patient recovered and platelet count reverted to the normal level. HIT may occur in patients treated with heparin and may increase the mortality risk if the diagnosis is delayed.
Since heparin sodium is widely used in many microsurgical reconstructions, surgeons should be aware that even a very small quantity of heparin sodium can invite adverse consequences.