Petros Kapsetakis1, Georgios Magarakis1, Constantinos Chaniotakis1, Phaedon D Zavras2, Georgios Kavalaris3, Christos Koutserimpas4, Kalliopi Alpantaki1. 1. Department of Orthopaedics and Trauma, Venizeleion General Hospital of Heraklion, Crete, Greece. 2. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. 3. Department of Radiology, Venizeleion General Hospital of Heraklion, Crete, Greece. 4. Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece.
Abstract
Introduction: Prophylactic anticoagulation (AC) with low molecular weight heparins (LMWHs) following hip fracture has reduced the incidence of severe thromboembolic events. However, heparin-induced thrombocytopenia (HIT) remains a serious complication in these patients. Clinical case: We report an unusual case of thrombosis due to severe HIT in a 75-year-old female patient following intramedullary nailing for a hip fracture. The patient was taking Verapamine. On the fourth postoperative day she developed paralysis, paresthesia and mild pain over the right lower extremity; faint pulses were palpated. Computed tomography angiogram identified superficial artery occlusion leading to limb ischemia. Anti-platelet factor 4 (PF4) heparin antibody positivity confirmed the diagnosis of HIT. Urgent embolectomy was performed and the patient achieved full recovery. Discussion: Arterial embolism presenting with severe neurological deficits is a rare complication of HIT. Conclusion: A high index of suspicion and close platelet count monitoring is warranted for early diagnosis and treatment of this devastating condition that can be limb and life threatening.
Introduction: Prophylactic anticoagulation (AC) with low molecular weight heparins (LMWHs) following hip fracture has reduced the incidence of severe thromboembolic events. However, heparin-induced thrombocytopenia (HIT) remains a serious complication in these patients. Clinical case: We report an unusual case of thrombosis due to severe HIT in a 75-year-old female patient following intramedullary nailing for a hip fracture. The patient was taking Verapamine. On the fourth postoperative day she developed paralysis, paresthesia and mild pain over the right lower extremity; faint pulses were palpated. Computed tomography angiogram identified superficial artery occlusion leading to limb ischemia. Anti-platelet factor 4 (PF4) heparin antibody positivity confirmed the diagnosis of HIT. Urgent embolectomy was performed and the patient achieved full recovery. Discussion: Arterial embolism presenting with severe neurological deficits is a rare complication of HIT. Conclusion: A high index of suspicion and close platelet count monitoring is warranted for early diagnosis and treatment of this devastating condition that can be limb and life threatening.
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