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Case Reports
. 2019 Jun 28;3(2):e200-e202.
doi: 10.1055/s-0039-1692990. eCollection 2019 Apr.

Autoimmune Heparin-Induced Thrombocytopenia after Transcatheter Aortic Valve Implantation: Successful Treatment with Adjunct High-Dose Intravenous Immunoglobulin

Tamam Bakchoul  1 , Oliver Borst  2 , Reimer Riessen  3 , Josip Lucic  1 , Meinrad Gawaz  2 , Karina Althaus  1 , Parwez Aidery  2
Affiliations
Case Reports

Autoimmune Heparin-Induced Thrombocytopenia after Transcatheter Aortic Valve Implantation: Successful Treatment with Adjunct High-Dose Intravenous Immunoglobulin

Tamam Bakchoul et al. TH Open. .

Abstract

We describe a rare case of autoimmune heparin-induced thrombocytopenia after transcatheter aortic valve implantation in which antibodies against platelet factor 4/heparin have led to platelet activation even after heparin cessation, causing a delayed drop in platelet count to below 20 × 10 9 /L. Most interestingly, platelet count rapidly improved after intravenous immunoglobulin treatment and no new thromboembolic complications were observed with further anticoagulation with rivaroxaban.

Keywords: antibody; heparin; thrombocytopenia.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
( A ) Recovery in platelet count in an autoimmune HIT after transcatheter aortic valve. (B) The impact of IVIG on platelet activation by autoimmune HIT antibodies. Patient's serum was incubated with platelets from four healthy donors in the presence of 0.2 IU/mL LMWH (reviparin) and different concentrations of IVIG. Platelet activation was determined by measurement of time until platelet aggregation in the HIPA assay. DAPT, dual antiplatelet therapy; DOAC, direct oral anticoagulant; HIT, heparin-induced thrombocytopenia; IVIG, intravenous immunoglobulin; LMWH, low-molecular-weight heparin; MAb IV.3, Fc gamma receptor IIa blocking monoclonal antibody.
See this image and copyright information in PMC

References

    1. Bakchoul T, Marini I. Drug-associated thrombocytopenia. Hematology (Am Soc Hematol Educ Program) 2018;2018(01):576–583. - PMC - PubMed
    1. Warkentin T E. Heparin-induced thrombocytopenia-associated thrombosis: from arterial to venous to venous limb gangrene. J Thromb Haemost. 2018;16(11):2128–2132. - PubMed
    1. Greinacher A. Clinical Practice. Heparin-induced thrombocytopenia. N Engl J Med. 2015;373(03):252–261. - PubMed
    1. Greinacher A, Selleng K, Warkentin T E. Autoimmune heparin-induced thrombocytopenia. J Thromb Haemost. 2017;15(11):2099–2114. - PubMed
    1. Tvito A, Bakchoul T, Rowe J M, Greinacher A, Ganzel C. Severe and persistent heparin-induced thrombocytopenia despite fondaparinux treatment. Am J Hematol. 2015;90(07):675–678. - PubMed

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