Lepirudin Treatment in a Girl with Iliac Vein Thrombosis, Severe Pulmonary Embolism and Suspected Heparin-induced Thrombocytopenia (HIT) II

Abstract

We report on a 15-year-old girl referred to us for dyspnea. Investigations revealed multiple pulmonary emboli originating from iliac vein thrombosis. As under heparin therapy, d-dimers rose again and the thrombus grew significantly in size while platelet count decreased by >30%. A diagnosis of heparin-induced thrombocytopenia (HIT) type II was suspected, heparin-treatment was stopped and lepirudin therapy was started successfully at a dosis of 0.15 mg/kg bw/hr.

Zusammenfassung

Wir berichten von einem 15-jährigen Mädchen, das wegen Luftnot vorgestellt wurde; ursächlich waren multiple Lungenembolien aufgrund einer tiefen Beinvenenthrombose. Da der Thrombus trotz Heparintherapie an Größe zunahm, wurde der Verdacht auf eine heparininduzierte Thrombozytopenie (HIT) Typ II gestellt.

Key words

heparin-induced thrombocytopenia - HIT type II - Lepirudin - thromboembolism - Hirudin

Schlüsselwörter

heparininduzierte Thrombozytopenie - HIT Typ II - Lepirudin - Thromboembolie - Hirudin

References

• 1 Deitcher SR, Ngengwe R, Kaplan R. et al . Subcutaneous lepirudin for heparin-induced thrombocytopenia and when other anticoagulants fail: illustrative cases.  Clin Adv Hematol Oncol. 2004;  2 382-384 , ; discussion 384–386
• 2 Girolami B, Girolami A. Heparin-induced thrombocytopenia: a review.  Semin Thromb Hemost. 2006;  32 803-809
• 3 Gobel U, Witt O. Pitfalls of clinical registries in pediatric oncology and hematology.  Klin Padiatr. 2008;  220 129-133
• 4 Lubenow N, Greinacher A. Drugs for the prevention and treatment of thrombosis in patients with heparin-induced thrombocytopenia.  Am J Cardiovasc Drugs. 2001;  1 429-443
• 5 Monagle P, Chan A, Massicotte P. et al . Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126 645S-687S
• 6 Risch L, Fischer JE, Herklotz R. et al . Heparin-induced thrombocytopenia in paediatrics: clinical characteristics, therapy and outcomes.  Intensive Care Med. 2004;  30 1615-1624
• 7 Warkentin TE. Think of HIT.  Hematology Am Soc Hematol Educ Program. 2006;  408-414

Correspondence