Idiopathic catastrophic thrombosis with happy end - a case report
J. Heid, H. A. Katus, O. Müller (Heidelberg, Germany)
Time: 17:15 - 18:15
Objective: A 59 year old male patient suffered three life threatening stent thromboses after an initial resuscitation due to a STEMI of the anterior cardiac wall. With a high risc profile for a Heparin Induced Thrombocytopenia Typ II (HIT II) he was placed on argatroban after the second reinfarction. Under this apparently appropriate treatment a third reinfarction happened and the patient had to undergo high risc cardiac bypass surgery. Later on a deep vein thrombosis and an intracardiac thrombus formed.
Methods: Case report
Results: Despite a positive screening test for HIT II and a single positive result in the Heparin incuded platelet aggregation (HIPA) test we are not convinced that HIT II was the only underlying cause for this “catastrophic thrombotic syndrome”. We assume that a massive generation of thrombin, reflected in consistently high D-dimers and the need of copious amounts of a direct thrombin inhibitor, triggered the set of events.
Conclusion: With this case report we want to raise awareness for cardiac complications in complex haemostasiological cases and share our experiences in the diagnostic and therapeutic management of these delicate patients.