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Hirudin therapy during thrombolysis for venous thrombosis in heparin-induced thrombocytopenia

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Richard Weiss

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Alan Askenase

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Catherine Tuite

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Michael Soulen

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Emile R Mohler, III

Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Heparin-induced thrombocytopenia (HIT) is the most common drug-related thrombocytopenia. Thromboembolic complications occur in approximately 50% of patients with HIT and result in limb amputation and death in up to 20% and 30% respectively. Because patients with a history of HIT may require future intravenous anticoagulation but have a high-risk of thromboembolism if re-challenged with heparin, alternative therapies are necessary when further anticoagulation is indicated. The use of direct thrombin inhibitors in HIT patients who also require thrombolytic therapy offers unique challenges to anticoagulant monitoring and safety. We present a case of progressive ileofemoral deep venous thrombosis in a patient with a history of HIT in order to review the combined use of hirudin and thrombolysis in this setting.

Key Words: deep venous thrombosis • heparin-induced thrombocytopenia • hirudin • thrombolysis

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