• Am J Health Syst Pharm · May 2014

    Case Reports

    Use of argatroban and catheter-directed thrombolysis with alteplase in an oncology patient with heparin-induced thrombocytopenia with thrombosis.

    • Brian Dee, Lindsey Lombardi Thomas, and Alison Gulbis.
    • Brian Dee, Pharm.D., BCPS, BCNSP, is Clinical Pharmacy Specialist-Critical Care/Nutrition Support; Lindsey Lombardi Thomas, Pharm.D., BCOP, is Clinical Pharmacy Specialist-Stem Cell Transplantation; and Alison Gulbis, Pharm.D., BCOP, is Clinical Pharmacy Specialist-Stem Cell Transplantation, Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston.
    • Am J Health Syst Pharm. 2014 May 1;71(9):711-6.

    PurposeThe 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.SummaryA 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.ConclusionA 63-year-old man with renal amyloidosis and SVC syndrome secondary to HITT was successfully treated with argatroban and CDT with alteplase.

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