A CASE OF ARGATROBAN REFRACTORY HEPARIN INDUCED THROMBOCYTOPENIA AND THROMBOSIS WITH LEFT VENTRICULAR THROMBUS

Objectives: For decades, it has been an accepted practice to administer antithrombotic prophylactic unfractionated heparin (UFH) or low molecular weight heparin (LMWH) to post-operative patients. The most important non-hemorrhagic complication of heparin administration is heparin-induced thrombocytopenia (HIT). Although most patients do not experience any adverse effects, literature states that 0.5%-1% of patients on UFH and 0.1%-0.5% of patients on LMWH experience thrombocytopenia. In light of such complications, argatroban has been widely considered a viable treatment option in patients who develop HIT. We will present a case of a 75-year-old male that had argatroban refractory HIT after a coronary artery bypass grafting resulting in a left ventricular thrombus and death. There is a paucity of literature on the topic of argatroban refractory HIT. When it is discussed, the persistent drop of platelets and ongoing thrombosis, despite argatroban therapy, appears to be the hallmark. The treatment being used in these rare cases is intravenous immunoglobulin. Our case, although not one describing treatment, sheds light on the existence of this entity and helps consolidate some literature on the topic.

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