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Case Reports in Medicine
Volume 2013 (2013), Article ID 586989, 4 pages
http://dx.doi.org/10.1155/2013/586989
Case Report

Successful Management of Heparin-Induced Thrombocytopenia Using Argatroban in a Very Old Woman: A Case Report

1Service de Médecine Interne Gériatrie, Hôpital de Jour, Hôpital de Champmaillot CHU BP 87909, 2 rue Jules Violle, 21079 Dijon Cedex, France
2Service d’Hématologie Biologique Hôpital du Bocage CHU, BP 87909, 21079 Dijon Cedex, France
3INSERM/U1093 Motricité-Plasticité: Performance, Dysfonctionnement, Vieillissement et Technologies d'Optimisation, Université de Bourgogne, Faculté des Sciences du Sport, 21078 Dijon, France

Received 6 November 2012; Revised 7 February 2013; Accepted 13 February 2013

Academic Editor: Dierk Thomas

Copyright © 2013 A. Putot et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thrombosis due to heparin-induced thrombocytopenia (HIT) is rare but has a severe prognosis. Its management is not always easy, particularly in old patients with renal insufficiency. A 95-year-old woman was hospitalized for dyspnea. Curative treatment with unfractionated heparin was started because pulmonary embolism was suspected. Disseminated intravascular coagulation was then suspected because of thrombocytopenia, hypoprothrombinemia, hypofibrinogenemia, and a positive ethanol gelation test. The first immunoassay for HIT was negative. On the 12th day of hospitalization, bilateral cyanosis of the toes occurred associated with recent deep bilateral venous and arterial thrombosis at duplex ultrasound. New biological tests confirmed HIT and led us to stop heparin and to start argatroban with a positive clinical and biological evolution. Venous and arterial thrombosis associated with thrombocytopenia during heparin treatment must be considered HIT whatever the biological test results are. Argatroban is a good alternative treatment in the elderly.