A Case in Which Deep-vein Thrombosis (DVT) of the Leg Worsened Due to Heparin-induced Thrombocytopenia (HIT) Improved after Fibrinolytic Therapy Using a Large Dosage of Urokinase (UK)

Abstract

The patient was a 73-year-old male who was administered umkinase (UK) and heparin treatment for deep-vein thrombosis (DVT) in the left leg at a dosage of 10,000-units/day/7 days. Twelve days after the start of heparin administration, the number of platelets rapidly decreased and the swelling in the leg worsened, thus resulting in his being transferred to another hospital where he was diagnosed to have heparin-induced thrombocytopenia (HIT) and DVT which had worsened due to HIT. A total of four treatments of alternating anticoagulation using argatroban and thrombolytic therapy at a large UK dosage of 720,000 units (3,000 units/kg/hour) were performed. The pain in the leg immediately subsided after the large amount of UK was administered, and the swelling in the leg started to improve two days later. Thereafter, the UK dosage was first reduced to 120,000 units and then further gradually decreased until the administration was finally terminated. The number of platelets gradually recovered and no complications in either arterial tlu•ombosis or thmmbophlebitis were newly observed when the patient was discharged from the hospital. This patient represents one example m which DVT worsened due HIT, however, it was successfully treated by a large dosage of UK.