Author Information

An event is serious (FDA MedWatch definition) when the patient outcome is:

  • * death

  • * life-threatening

  • * hospitalisation

  • * disability

  • * congenital anomaly

  • * requires intervention to prevent permanent impairment or damage

A 59-year-old woman developed heparin-induced thrombocytopenia (HIT) leading to an acute compartment syndrome that caused acute lower-extremity paralysis, renal infarct, deep venous thromboses, pulmonary embolisms causing respiratory failure following treatment with heparin.

The woman underwent a laminectomy due to a severe spinal stenosis with grade 1 spondylolisthesis. On postoperative day 1 (POD), she started receiving unfractionated SC heparin 5000U three times daily for prophylaxis. Prior to the initiation of heparin, her platelet count was 128 /µL. She continued heparin prophylaxis for the duration of her initial hospitalisation. Her post-operative course was complicated by an ileus, which then resolved with bowel rest. On POD 7, she was discharged on with a stable intact neurological examination. On POD 7, her platelet count was 203 /µL. On POD 14, she presented to the emergency department, where she was found to be in severe respiratory distress with acute lower-extremity weakness. She had palpable pulses in the upper extremities and groin, but distal to her groin, she did not have palpable pulses or pulses evident on Doppler ultrasonography. Due to the respiratory distress, she was intubated and her subsequent laboratory investigations revealed multiple pulmonary embolism, a renal infarct and deep vain thromboses in both her iliac and femoral veins bilaterally. Her platelet count was 59 /µL and her HIT immunoassay was positive.

The woman received treatment with argatroban. Based on her lower-extremity findings, she was diagnosed with acute compartment syndrome and was taken to the operating room for bilateral groin cut-downs, bilateral ilio-femoral thrombectomies, and right anterior/lateral/posterior fasciotomies. She had a prolonged recovery from her multisystem injury but was eventually discharged on hospitalisation day 31 with 1–2/5 strength in her right lower extremity and full recovery of her left lower-extremity strength. She was discharged on a regimen of long-term warfarin. Approximately seven months after her initial operation and 6.5 months after the HIT presentation; a follow-up physical examination showed no perceptible weakness; however, residual sensory deficits persisted.

Author comment: "The risk of [heparin-induced thrombocytopenia] appears to be slightly higher in women and appears to be up to 10 times higher in patients exposed to unfractionated heparin than those exposed to low-molecular-weight heparin; both risk factors were present in our patient." "This patient went on to develop compartment syndrome that caused [. . .] pulmonary embolisms causing respiratory failure."