Abstract

Background: Heparin-induced thrombocytopenia (HIT) is a severe immune-mediated complication of heparin therapy, potentially leading to life-threatening thrombotic events, referred to as HIT with thrombosis (HITT).

Case Presentation: We report the case of a 46-year-old female patient with severe peripheral arterial occlusive disease who developed acute HITT after undergoing a covered endovascular reconstruction of the aortic bifurcation (CERAB). Perioperative heparin was administered during CERAB procedure. Low-molecular-weight heparin (LMWH), initially prescribed postoperatively, was replaced by apixaban due to thrombocytopenia. Despite this, an intra-stent thrombosis occurred, requiring urgent surgical revascularization.

Intervention and Outcome: HITT was confirmed by a positive anti-PF4/heparin antibody assay and validated by functional platelet activation tests. Surgery was performed under danaparoid anticoagulation. Thrombectomy was achieved using a Fogarty catheter. The patient’s limb was reperfused, her platelet count normalized, and no hemorrhagic complications occurred. Postoperative management included a tailored anticoagulation regimen.

Conclusion: Anticoagulation is the cornerstone of HITT. Vascular surgery in this pathology is particularly challenging due to the need for perioperative anticoagulation while avoiding heparin exposure. This case illustrates the importance of early recognition and personalized perioperative management in HITT. A multidisciplinary approach is essential to ensure optimal outcomes while mitigating both thrombotic and hemorrhagic risks.