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....
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American College of Physicians
2022-05-01
|
| Series: | Annals of Internal Medicine: Clinical Cases |
| Online Access: | https://www.acpjournals.org/doi/10.7326/aimcc.2022.0091 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850202488720850944 |
|---|---|
| author | Rémy Hamdan Valentin Crespy Georges Tarris Philippe Savard |
| author_facet | Rémy Hamdan Valentin Crespy Georges Tarris Philippe Savard |
| author_sort | Rémy Hamdan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-ab88d697296b4ab49bdec1594da9537e |
| institution | OA Journals |
| issn | 2767-7664 |
| language | English |
| publishDate | 2022-05-01 |
| publisher | American College of Physicians |
| record_format | Article |
| series | Annals of Internal Medicine: Clinical Cases |
| spelling | doaj-art-ab88d697296b4ab49bdec1594da9537e2025-08-20T02:11:46ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642022-05-011310.7326/aimcc.2022.0091Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot SyndromeRémy Hamdan0Valentin Crespy1Georges Tarris2Philippe Savard31Department of Angiology, Dijon Bourgogne University Hospital, Dijon, France2Department of Cardiovascular and Thoracic Surgery, Dijon Bourgogne University Hospital, Dijon, France3Department of Pathology, Dijon Bourgogne University Hospital, Dijon, France4Department of Biological Haematology, Dijon Bourgogne University Hospital, Dijon, FranceTwo 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.https://www.acpjournals.org/doi/10.7326/aimcc.2022.0091 |
| spellingShingle | Rémy Hamdan Valentin Crespy Georges Tarris Philippe Savard Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome Annals of Internal Medicine: Clinical Cases |
| title | Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome |
| title_full | Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome |
| title_fullStr | Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome |
| title_full_unstemmed | Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome |
| title_short | Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome |
| title_sort | acute limb ischemia after cardiac surgery looking for the white clot syndrome |
| url | https://www.acpjournals.org/doi/10.7326/aimcc.2022.0091 |
| work_keys_str_mv | AT remyhamdan acutelimbischemiaaftercardiacsurgerylookingforthewhiteclotsyndrome AT valentincrespy acutelimbischemiaaftercardiacsurgerylookingforthewhiteclotsyndrome AT georgestarris acutelimbischemiaaftercardiacsurgerylookingforthewhiteclotsyndrome AT philippesavard acutelimbischemiaaftercardiacsurgerylookingforthewhiteclotsyndrome |