Massive pulmonary embolism due to late-onset heparin-induced thrombocytopenia following coronary artery bypass graft surgery: successful treatment with lepirudin.

Most cardiac surgical patients have had previous exposure to heparin for diagnostic or therapeutic interventions and hence have an increased susceptibility to developing heparin-induced thrombocytopenia (HIT) postoperatively. HIT is an immune-mediated adverse drug reaction that may be associated with limb or life-threatening thrombosis. Heparin cessation is a vital first step in treatment; however, alternative anticoagulant therapy is essential. Recombinant hirudin (lepirudin), a thrombin-specific inhibitor, provides safe and effective anticoagulation in such patients. We describe a case of delayed onset HIT with resulting massive pulmonary embolism postcardiac surgery that was successfully managed with lepirudin.