Extensive life-threatening thrombosis in a patient with heparin-induced thrombocytopenia and factor V Leiden mutation.

A 67-year old man, receiving subcutaneous unfractionated heparin for 18 days was admitted because of femoral artery thrombosis. Biochemical analysis showed thrombocytopenia (29×109/L) and a positive test for heparin-dependent antiplatelet antibodies. Heparin-induced thrombocytopenia (HIT) was diagnosed. Computed tomography (CT) showed extensive thrombosis (Figure 1). Doppler ultrasonography demonstrated venous thrombosis in both legs. The unfractionated heparin (UHF) was stopped and the patient was treated with danaparoid sodium followed by warfarin. A CT scan was repeated 14 days later (Figure 2). Further investigations revealed the presence of Factor V Leiden (FVL). FVL has been recently reported in 9.7% of HIT,1 with no additive risk for thrombotic complications.1 Francesca Pizzolo, Domenico Girelli, Oliviero Olivieri Department of Clinical and Experimental Medicine, University of Verona, Italy Correspondence: Professor Oliviero Olivieri, M.D., Department of Clinical and Experimental Medicine, University of Verona, Policlinico G.B. Rossi, 37134 Verona, Italy. Phone/Fax: international +39.045.580111. E-mail: [email protected]