Work

Explosive Multiterritorial Arterial Thrombosis Following Brief Heparin Exposure: A Diagnostic Pitfall in the Cath Lab

Year: 2026

Type: article

Abstract: Background: Type II heparin-induced thrombocytopenia (HIT) is a catastrophic immunothrombotic disorder that can be triggered by minimal heparin exposure during routine coronary angiography. Case Summary: A 67-year-old woman developed "explosive" multiterritorial arterial thrombosis-including acute limb ischemia, an inferior STEMI, and a stroke-within minutes of receiving 5000 units of intra-arterial heparin. This followed a brief nadroparin exposure 8 days prior. Crucially, events occurred while platelet counts were still normal. Despite a negative functional assay, a high 4T score (6 points) confirmed HIT. Management involved non-heparin anticoagulation (danaparoid sodium) and thrombectomies. Discussion: This case highlights a major diagnostic pitfall: severe arterial thrombosis preceding overt thrombocytopenia. The immediate "anaphylactoid-like" reaction following a heparin bolus is often misidentified as contrast allergy, delaying life-saving intervention. Take Home Messages: Suspect HIT in acute systemic reactions or multifocal thrombosis after heparin exposure, regardless of initial platelet counts.

Source: Case Reports in Cardiology

DOI: 10.1155/cric/6999917

Authors: Justine Massart, Claudiu Ungureanu, Yves Dascotte, Jacques Auslender, Adrien Jossart

Institutions: Hôpital de Jolimont, UCLouvain

Language: English

Topic: Heparin-Induced Thrombocytopenia and Thrombosis

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790