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Use of argatroban and catheter-directed thrombolysis with alteplase in an oncology patient with heparin-induced thrombocytopenia with thrombosis.
[heparin-induced thrombocytopenia]
The
case
of
an
oncology
patient
who
developed
heparin-induced
thrombocytopenia
with
thrombosis
(
HITT
)
and
was
treated
with
argatroban
plus
catheter-directed
thrombolysis
(
CDT
)
with
alteplase
is
presented
.
A
63
-
year
-old
Caucasian
man
with
renal
amyloidosis
undergoing
peripheral
blood
stem
cell
collection
for
an
autologous
stem
cell
transplant
developed
extensive
bilateral
upper
-extremity
deep
venous
thrombosis
(
DVT
)
and
pulmonary
embolism
secondary
to
heparin-induced
thrombocytopenia
.
A
continuous
i
.
v
.
infusion
of
argatroban
was
initiated
,
and
the
patient
was
managed
on
the
general
medical
floor
.
After
one
week
of
therapy
,
he
was
transferred
to
the
intensive
care
unit
with
cardiopulmonary
compromise
related
to
superior
vena
cava
(
SVC
)
syndrome
.
A
percutaneous
mechanical
thrombectomy
and
CDT
with
alteplase
were
attempted
,
but
the
procedure
was
aborted
due
to
epistaxis
.
The
epistaxis
resolved
the
next
day
,
and
the
patient
was
restarted
on
argatroban
.
A
second
percutaneous
mechanical
thrombectomy
was
performed
six
days
later
and
resulted
in
partial
revascularization
of
the
SVC
and
central
veins
.
Postthrombectomy
continuous
CDT
with
alteplase
was
commenced
while
argatroban
was
withheld
,
and
complete
patency
of
the
SVC
and
central
veins
was
achieved
after
three
days
of
therapy
.
Alteplase
was
discontinued
,
and
the
patient
was
reinitiated
on
argatroban
;
ultimately
,
he
was
transitioned
to
warfarin
for
long
-term
anticoagulation
.
Although
the
patient
recovered
,
he
experienced
permanent
vision
and
hearing
loss
,
as
well
as
end-
stage
renal
disease
.
A
63
-
year
-old
man
with
renal
amyloidosis
and
SVC
syndrome
secondary
to
HITT
was
successfully
treated
with
argatroban
and
CDT
with
alteplase
.
Diseases
Validation
Diseases presenting
"hearing loss"
symptom
22q11.2 deletion syndrome
achondroplasia
adrenomyeloneuropathy
alexander disease
benign recurrent intrahepatic cholestasis
canavan disease
cohen syndrome
congenital toxoplasmosis
dentinogenesis imperfecta
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
kabuki syndrome
kallmann syndrome
neonatal adrenoleukodystrophy
pendred syndrome
von hippel-lindau disease
wolf-hirschhorn syndrome
This symptom has already been validated