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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
.