Abstract
Heparin-induced thrombocytopenia is rare and its prognosis is poor. An 80-year-old woman underwent ascending aorta replacement for acute type A aortic dissection but pulmonary thromboembolism occurred on postoperative day 10. We initiated heparin administration, but pneumonia occurred and suffered septic shock on postoperative day 14. We started platelet transfusion because we suspected disseminated intravascular coagulation. However, her platelet count decreased rapidly to 4000/µl and the platelet factor 4-reactive heparin-induced thrombocytopenia antibody testing was positive. We stopped heparin administration and started intravenous argatroban resulting in an increase in her platelet count to 300,000/µl on postoperative day 30. It was difficult to distinguish between heparin-induced thrombocytopenia and disseminated intravascular coagulation in the present case.
