A case of tongue cancer complicated by heparin-induced thrombocytopenia during perioperative management. Issue 5 (September 2021)

• Record Type: Journal Article
• Authors: Nakanishi, Yasuhiro; Tamura, Masashi; Takahashi, Miho; Izawa, Kazumi; Mizusawa, Nobuhito; Yamazaki, Hiroshi; Watanabe, Daisuke; Kato, Hisashi; Karakida, Kazunari; Kaneko, Akihiro
• Is Part Of: Journal of oral and maxillofacial surgery, medicine, and pathology. Volume 33:Issue 5(2021)
• Page Start: 526
• Page End: 531
• Publication Date: 2021-09
• Subjects: HIT heparin-induced thrombocytopenia -- PT-INR prothrombin time-international normalized ratio -- CT computed tomography -- PF4 platelet factor 4 -- TAZ/PIPC Tazobactam/piperacillin -- LVFX levofloxacin -- ELISA enzyme-linked immunosorbent assay; Heparin-induced thrombocytopenia -- Tongue cancer -- Warfarin -- Thrombosis -- Complication; Mouth -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Oral medicine -- Periodicals; Mouth -- Diseases -- Pathogenesis -- Periodicals; Surgery, Oral -- Periodicals; Oral Medicine -- Periodicals; Pathology, Oral -- Periodicals; Face -- Surgery; Maxilla -- Surgery; Mouth -- Diseases -- Pathogenesis; Mouth -- Surgery; Oral medicine; Electronic journals -- Sciences; Electronic journals -- Medicine; Periodicals; 617.522059
• DOI: 10.1016/j.ajoms.2021.02.015
• Languages: English
• ISSNs: 2212-5566

Abstract

Abstract: In patients with vascular diseases, heparinization is necessary for surgery. Here, we report the case of a 77-year-old man who presented with heparin-induced thrombocytopenia (HIT) during the postoperative management of tongue cancer. The patient was already on warfarin owing to arteriosclerosis obliterans, and was perioperatively administered heparin by a cardiologist. The prothrombin time-international normalized ratio (PT-INR) was stabilized, and heparin administration was terminated on postoperative day 23. However, on postoperative day 41, the PT-INR was prolonged; warfarin was discontinued, and heparin was re-administered. On day 6 after heparin re-administration (postoperative day 47), the patient developed sudden fever. Contrast-enhanced computed tomography (CT) imaging was performed to evaluate the fever and showed a thrombus at the L5 level of the inferior vena cava. Blood examination showed a platelet count of 108, 000 /μL; however, the next day, the count was 87, 000 /μL. On day 10 after heparin re-administration (postoperative day 51), contrast-enhanced CT imaging showed an increase in thrombus formation. Therefore, inferior vena cava filter insertion surgery was performed on day 13 of heparin re-administration (postoperative day 54). The patient was diagnosed with HIT because of thrombocytopenia and increased thrombin after the re-administration of heparin, which was discontinued on postoperative day 64; argatroban (an anti-thrombin drug) was administered for HIT treatment. The patient was discharged with an indwelling inferior vena cava filter and intestinal fistula.