Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia
Summary: We report the case of a 61‐year‐old female who developed heparin‐induced thrombocytopaenia following treatment of a submassive pulmonary embolism, and who then required an above knee amputation for critical limb ischaemia. Heparin‐induced thrombocytopaenia is a rare, immune‐mediated complic...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley Open Access
2024
|
| _version_ | 1811140017600331776 |
|---|---|
| author | Perera, Y Taylor, R Bera, KD Holman, L Curry, N Shah, A |
| author_facet | Perera, Y Taylor, R Bera, KD Holman, L Curry, N Shah, A |
| author_sort | Perera, Y |
| collection | OXFORD |
| description | Summary: We report the case of a 61‐year‐old female who developed heparin‐induced thrombocytopaenia following treatment of a submassive pulmonary embolism, and who then required an above knee amputation for critical limb ischaemia. Heparin‐induced thrombocytopaenia is a rare, immune‐mediated complication associated with an in‐hospital mortality rate of 10%. It is more common in surgical patients, with patients undergoing orthopaedic surgery more likely to develop it than patients undergoing cardiac surgery, but heparin‐dependent immunoglobulin G antibodies are more likely to be formed in the latter. Peri‐operative management remains a challenge. Ideally, it is preferable to wait for the platelet count to improve; but in certain cases, surgery cannot be delayed. Heparin‐induced thrombocytopaenia is usually managed with direct thrombin inhibitors, such as argatroban and bivalirudin. Newer therapeutic modalities, such as plasmapheresis and intravenous immunoglobulin, as used in this case, can rapidly remove antibodies, but the certainty of evidence is low. Our case adds to the literature regarding the use of these modalities and highlights the multidisciplinary team approach required to manage such complex cases. |
| first_indexed | 2024-09-25T04:15:18Z |
| format | Journal article |
| id | oxford-uuid:4ccf346f-d9bb-4bf4-bfa9-de7a1cecb979 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:15:18Z |
| publishDate | 2024 |
| publisher | Wiley Open Access |
| record_format | dspace |
| spelling | oxford-uuid:4ccf346f-d9bb-4bf4-bfa9-de7a1cecb9792024-07-17T20:03:44ZPlasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemiaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:4ccf346f-d9bb-4bf4-bfa9-de7a1cecb979EnglishJisc Publications RouterWiley Open Access2024Perera, YTaylor, RBera, KDHolman, LCurry, NShah, ASummary: We report the case of a 61‐year‐old female who developed heparin‐induced thrombocytopaenia following treatment of a submassive pulmonary embolism, and who then required an above knee amputation for critical limb ischaemia. Heparin‐induced thrombocytopaenia is a rare, immune‐mediated complication associated with an in‐hospital mortality rate of 10%. It is more common in surgical patients, with patients undergoing orthopaedic surgery more likely to develop it than patients undergoing cardiac surgery, but heparin‐dependent immunoglobulin G antibodies are more likely to be formed in the latter. Peri‐operative management remains a challenge. Ideally, it is preferable to wait for the platelet count to improve; but in certain cases, surgery cannot be delayed. Heparin‐induced thrombocytopaenia is usually managed with direct thrombin inhibitors, such as argatroban and bivalirudin. Newer therapeutic modalities, such as plasmapheresis and intravenous immunoglobulin, as used in this case, can rapidly remove antibodies, but the certainty of evidence is low. Our case adds to the literature regarding the use of these modalities and highlights the multidisciplinary team approach required to manage such complex cases. |
| spellingShingle | Perera, Y Taylor, R Bera, KD Holman, L Curry, N Shah, A Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title | Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title_full | Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title_fullStr | Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title_full_unstemmed | Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title_short | Plasma exchange and intravenous immunoglobulin for the peri‐operative management of type 2 heparin‐induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| title_sort | plasma exchange and intravenous immunoglobulin for the peri operative management of type 2 heparin induced thrombocytopaenia in a patient requiring urgent surgery for critical limb ischaemia |
| work_keys_str_mv | AT pereray plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia AT taylorr plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia AT berakd plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia AT holmanl plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia AT curryn plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia AT shaha plasmaexchangeandintravenousimmunoglobulinfortheperioperativemanagementoftype2heparininducedthrombocytopaeniainapatientrequiringurgentsurgeryforcriticallimbischaemia |