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Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review

Authors :
Seyyed Mojtaba Nekooghadam
Sepehr Ebrahimi‐Dehkordi
Elham Paraandavaji
Mehdi Pishgahi
Erfan Ghadirzadeh
Elham Charkazi
Parastoo Ghorbani
Source :
Clinical Case Reports, Vol 11, Iss 8, Pp n/a-n/a (2023)
Publication Year :
2023
Publisher :
Wiley, 2023.

Abstract

Abstract The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low‐molecular‐weight heparin. Heparin‐induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6‐week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy‐related HIT. HIT is a pro‐coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.

Details

Language :
English
ISSN :
20500904
Volume :
11
Issue :
8
Database :
Directory of Open Access Journals
Journal :
Clinical Case Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.bc341d97c8245d7992f1ad6f3a63567
Document Type :
article
Full Text :
https://doi.org/10.1002/ccr3.7839