SHM Converge Scientific Abstract ePoster Gallery-A Hit to the Heart

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This case report describes a 66-year-old woman with hypertension, hyperlipidemia, and coronary artery disease who underwent three-vessel CABG with intraoperative heparin. After an initially uncomplicated recovery, she was discharged on postoperative day 7. On day 19, she returned with left leg pain, swelling, and erythema. Imaging showed an occlusive left lower-extremity DVT extending from the popliteal to the common femoral vein. A heparin drip was started, but she was soon found to have extensive pulmonary emboli with right heart strain, requiring urgent mechanical thrombectomy.<br /><br />Laboratory testing revealed a platelet drop from 209 at discharge to 82, raising concern for heparin-induced thrombocytopenia (HIT). Heparin was stopped immediately and replaced with fondaparinux. HIT was confirmed by antibody testing and serotonin-release assay. Due to the large clot burden, she also underwent thrombectomy for the DVT and was later transitioned to apixaban (Eliquis) for outpatient anticoagulation. Heparin was added to her allergy list, and follow-up was arranged with primary care, hematology, and cardiovascular surgery.<br /><br />The report emphasizes that HIT is an uncommon but serious complication after CABG, with significant risk of thrombosis, morbidity, and mortality if diagnosis is delayed. It also highlights that thrombocytopenia after CABG has a broad differential diagnosis, and that management becomes especially challenging when a patient is simultaneously thrombocytopenic and clotting. The authors stress the importance of thorough history-taking and chart review, as well as maintaining a high index of suspicion for HIT in post-CABG patients who develop thrombocytopenia and thrombosis.

Asset Subtitle

David W. Walsh

Meta Tag

Author List David W. Walsh, Harrell Heather

Category Clinical Vignettes

Concept Heparin-Induced Thrombocytopenia

Concept Thrombocytopenia

Concept Coronary Artery Bypass Grafting

Concept Differential Diagnosis

Concept Thrombosis

Distinguished Non-Finalist

Presenter Organization dawalsh@augusta.edu

Presenting Author David W. Walsh

Track Adult

Keywords

heparin-induced thrombocytopenia

CABG

deep vein thrombosis

pulmonary embolism

thrombocytopenia

fondaparinux

apixaban

mechanical thrombectomy

coronary artery disease

postoperative complication

Heparin-Induced Thrombocytopenia

Thrombocytopenia

Coronary Artery Bypass Grafting

Differential Diagnosis

Thrombosis