Recent Myocardial Infarction and Acute Heparin-Induced Thrombocytopenia: A Case Report on Perioperative Management of a Patient for Acute Limb Vascular Surgery

Case Reports

. 2022 Oct 27;14(10):e30763.

doi: 10.7759/cureus.30763.

eCollection 2022 Oct.


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Case Reports

Sara Nogueira et al.




The optimal alternative anticoagulation regimen for patients with heparin-induced thrombocytopenia (HIT) who need surgical procedures that involve higher levels of anticoagulation, usually performed under heparin, is not yet established. Argatroban has been reported as a safe alternative. Plasma levels and their anticoagulant effects follow a predictable profile. Also, it is easily monitored and its pharmacokinetic profile makes it suitable for patients with renal failure, as it undergoes hepatic elimination. However, its use as a substitute for heparin in HIT patients is not well-documented, especially in vascular surgery. We present a case of a successfully managed patient with acute HIT undergoing limb vascular surgery using anticoagulation with argatroban.


acute limb ischaemia; acute myocardial infarction; argatroban; heparin induced thrombocytopenia; perioperative period; vascular surgery.

Conflict of interest statement

The authors have declared that no competing interests exist.


Figure 1. Digital subtraction angiography showing occlusion of the right superficial femoral artery

Figure 2

Figure 2. Digital subtraction angiography showing limb revascularization


    1. Heparin-induced thrombocytopenia: a comprehensive clinical review. Salter BS, Weiner MM, Trinh MA, Heller J, Evans AS, Adams DH, Fischer GW. J Am Coll Cardiol. 2016;67:2519–2532.


    1. Heparin-induced thrombocytopenia: diagnosis and management. Hassell K. Thromb Res. 2008;123 Suppl 1:0–21.


    1. Vascular surgery using argatroban in a patient with a history of heparin-induced thrombocytopenia. Tokuda Y, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Yoshida K, Matsuo T. Circ J. 2003;67:889–890.


    1. Editor’s choice – European Society for Vascular Surgery (ESVs) 2020 clinical practice guidelines on the management of acute limb ischaemia. Björck M, Earnshaw JJ, Acosta S, et al. Eur J Vasc Endovasc Surg. 2020;59:173–218.


    1. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Cuker A, Arepally GM, Chong BH, et al. Blood Adv. 2018;2:3360–3392.



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