Graft-preserving intervention for treatment of heparin-induced thrombocytopenia secondary to a heparin-bonded renal artery bridging stent graft

Abstract

Heparin Induced Thrombocytopenia (HIT) is a well-recognized phenomenon in patients receiving heparin. Scoring systems such as the 4T score along with platelet factor 4 (PF4) testing have improved recognition and clinical improvement is typically observed soon after the diagnosis is made, heparin administration is ceased, and non-heparin anticoagulation is initiated. We report a case of HIT that was refractory to medical management in the setting of a recent fenestrated endovascular aneurysm repair which involved a heparin-bonded stent deployed in the left renal artery. In our patient, re-lining the heparin-bonded stent with a non-heparin bonded stent was associated with the resolution of his HIT.