Heparin-induced thrombocytopenia with antithrombin III deficiency can be a severe, fulminant systemic disease leading to disastrous complications and often death. An eighteen-month review of the authors' surgical population revealed 7 cases of heparin-induced thrombocytopenia. They present the diagnosis and management of these patients, as well as a literature review. On the basis of their experience, a platelet count that falls below 17% of the baseline should be the impetus to test for heparin-associated antibodies, protein C and S deficiency, and antithrombin III deficiency. Their newer recommendation, along with the use of saline flush and the start of coumadin early in the postoperative period, has prevented the complications associated with heparin-induced thrombocytopenia in their hospital for the past twelve months.
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