Work

Low molecular weight heparin-induced thrombocytopenia management during hemodialysis and cardiac surgery: a case report and literature review

Year: 2025

Type: article

Abstract: BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, including low molecular weight heparins (LMWHs) like dalteparin. While LMWHs reduces the risk of HIT compared to unfractionated heparin, vigilance remains essential. CASE PRESENTATION: An 82-year-old male with chronic kidney disease (CKD) developed HIT during hemodialysis anticoagulation with dalteparin, resulting in a platelet count of 17,000/µL and positive HIT antibodies. Dalteparin was replaced with nafamostat mesilate. Following confirmed HIT antibody seronegativity, elective aortic valve replacement was performed under cardiopulmonary bypass using heparin. Postoperative dialysis was managed using nafamostat mesilate, preventing HIT recurrence. His platelet count recovered after dalteparin replacement, and no recurrence of HIT was observed. CONCLUSIONS: Even LMWHs, such as dalteparin, pose a HIT risk, necessitating vigilant monitoring. Confirming HIT antibody seronegativity and appropriately timing surgery are critical for patients with a history of HIT. Proper postoperative follow-up and alternative anticoagulation strategies can prevent HIT recurrence.

Source: JA Clinical Reports

DOI: 10.1186/s40981-025-00781-0

Authors: Shuto Takada, Shogo Suzuki, Takahiro Tamura

Institutions: Nagoya University Hospital, Nagoya University

Language: English

Topic: Heparin-Induced Thrombocytopenia and Thrombosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,390