Acute Myocardial Infarction Caused by Delayed Heparin-Induced Thrombocytopenia and Acute Immunoreaction due to Re-exposure to Heparin in a Systemic Lupus Erythematosus Patient with HIT Antibodies
Free accessResearch articleFirst published online October, 2003
Acute Myocardial Infarction Caused by Delayed Heparin-Induced Thrombocytopenia and Acute Immunoreaction due to Re-exposure to Heparin in a Systemic Lupus Erythematosus Patient with HIT Antibodies
A patient with systemic lupus erythematosus and anticardiolipin antibodies and antibodies to platelet factor 4/heparin complexes suffered an acute myocardial infarction caused by delayed heparin-induced thrombocytopenia after heparin administration given to treat pulmonary hypertension. Furthermore, additional heparin administration for emergency coronary angiography appeared to have led to an acute immunoreaction, which might have resulted in acute coronary occlusion during coronary angiography and to a decreased platelet count. The present findings suggest that one must suspect delayed-type HIT in rare cases of induction of thrombosis after the cessation of heparin treatment, and avoid re-exposure to heparin in such cases.
1. Amiral J, Gridey F, Dreyfus M, et al. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. Thromb Haemost1992;68:95-95.
2.
2. Visentin G, Ford S, Scott J, Aster R.Antibodies from patients with heparin-induced thrombocytopenia/thrombosis are specific for platelet factor 4 complexed with heparin or bound to endothelial cells. J Clin Invest1994;93:81-81.
3.
3. Greinacher A, Potzsch B, Amiral J, Dummel V, Eichner A, Mueller-Eckhardt C.Heparin-associated thrombocytopenia: Isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen. Thromb Haemost1994;71:247-247.
4.
4. Kelton J, Smith J, Warkentin T, Hayward C, Denomme G, Horsewood P.Immunoglobulin G from patients with heparin-induced thrombocytopenia binds to a complex of heparin and platelet factor 4. Blood1994;83:3232-3232.
5.
5. Chong B, Pitney W, Cooley M, Chesterman C.Increased expression of platelet IgG Fc receptors in immune heparininduced thrombocytopenia. Blood1993;81:988-988.
6.
6. Warkentin T, Levine M, Hirsh J, et al. Heparin-induced thrombocytopenia in a patient treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med1995;332:1330-1330.
8. Suzuki S, Koide M, Sakamoto S, et al. Early onset of immunological heparin-induced thrombocytopenia in acute myocardial infarction. Blood Coag Fibrinol1996;8:13-13.
9.
9. Martinuzzo M, Forastiero R, Adamczuk Y, Pombo G, Carreras L.Antiplatelet factor 4-heparin antibodies in patients with antiphospholipid antibodies. Thromb Res1999;95:271-271.
10.
10. Wanstall J, Jeffery T.Recognition and management of pulmonary hypertension. Drugs1998;56:989-989.
11.
11. Vinatier D, Dufour P, Cosson M, Houpeau J.Antiphospholipid syndrome and recurrent miscarriages. Eur J Obstet Gynecol Reprod Biol2001;96:37-37.
12.
12. Chong B, Brugess J, Ismail F.The clinical usefulness of platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost1993;69:344-344.
13.
13. Arnout J.The pathogenesis of the antiphospholipid syndrome: A hypothesis based on parallelisms with heparininduced thrombocytopenia. Thromb Haemost1996;75:536-536.
15. Shi W, Chong B, Chesterman C.Bete 2-glycoprotein I is a requirement for anticardiolipin antibodies binding to activated platelets: Differences with lupus anticoagulant. Blood1993;81:1255-1255.
16.
16. Arvieux J, Roussel B, Pouzol P, Colomb M.Platelet activating properties of murine monoclonal antibodies to beta 2-glycoprotein I. Thromb Haemost1993;70:336-336.
17.
17. Hasselaar P, Derksen R, Oosting J, Blokzijl L, de Groot P.Synergistic effect of low doses of tumor necrosis factor and sera from patients with systemic lupus erythemotosus on the expression of procoagulant activity by cultured endothelial cells. Thromb Haemost1989;62:654-654.
18.
18. Warkentin T, Levine M, Hirsh J, Klama L, Kelton J.Formation of heparin-induced thrombocytopenia IgG without thrombocytopenia: Analysis of a clinical trial (abstract). Blood1995;86:537a-537a.
19.
19. Walenga J, Michal K, Hoppensteadt D, Wood J, Robinson J, Bick R. Vascular damage correlates between heparininduced thrombocytopenia and the antiphospholipid syndrome. Clin Appl Thromb Hemost1999;5:S76-S76.
20.
20. Cines D, Tomaski A, Tannenbaum S.Immune endothehalcell injury in heparin-associated thrombocytopenia. N Engl J Med1987;316:581-581.
21.
21. Greinacher A, Michels I, Mueller-Eckhardt C.Heparin-associated thrombocytopenia: The antibody is not heparin specific. Thromb Haemost1992;67:545-545.
22.
22. Kaikita K, Ogawa H, Yasue H, et al. Tissue factor expression on macrophages in coronary plaques in patients with unstable angina. Arterioscler Thromb Vasc Biol1997;17:2232-2232.
23.
23. Karrar A, Sequeira W, Block J.Coronary artery disease in systemic lupus erythematosus: A review of the literature. Semin Arthritis Rheum2001;30:436-436.
24.
24. Wallis D, Workman D, Lewis B, Steen L, Pifarre R, Moran J.Failure of early heparin cessation as treatment for heparin-induced thrombocytopenia. Am J Med1999;106:629-629.
25.
25. Rice L, Attisha W, Drexler A, Francis J.Delayed-onset heparin-induced thrombocytopenia. Ann Intern Med2002;136:210-210.
