Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome
Two weeks after undergoing cardiac surgery with cardiopulmonary bypass, a 59-year-old patient presented with acute right-limb ischemia. The probability of heparin-induced thrombocytopenia was high and heparin antibody immunoassays were positive, so heparin anticoagulation was replaced by argatroban....
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
American College of Physicians
2022-05-01
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| Series: | Annals of Internal Medicine: Clinical Cases |
| Online Access: | https://www.acpjournals.org/doi/10.7326/aimcc.2022.0091 |
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| Summary: | Two weeks after undergoing cardiac surgery with cardiopulmonary bypass, a 59-year-old patient presented with acute right-limb ischemia. The probability of heparin-induced thrombocytopenia was high and heparin antibody immunoassays were positive, so heparin anticoagulation was replaced by argatroban. An emergency right femoral thrombectomy yielded a macroscopically white thrombus that was rich in platelets and leukocytes on histopathological and immunologic analysis. Given that the serotonin-release assay is the gold standard and is technically demanding, type 2 heparin-induced thrombopenia is challenging to diagnose with certainty after cardiac surgery, so the white appearance of a thrombus obtained by emergency thrombectomy may help in decision-making. |
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| ISSN: | 2767-7664 |