Suspected delayed-onset heparin-induced thrombocytopenia from a heparin bonded PTFE axillofemoral bypass graft

Abstract

A 74-year-old man who underwent a left axillofemoral heparin-bonded polytetrafluoroethylene bypass grafting surgery presented acutely ill to the hospital one month later with a dehisced left groin surgical site wound and hypotension. Patient also found to be thrombocytopenic to 79K/µL on admission, nadiring to 15 K/µL by hospital day 7. New deep vein thromboses prompted heparin induced thrombocytopenia (HIT) screening leading to a diagnosis of HIT. The patient's last known heparin administration was 36 days prior to admission as flushes during the left axillofemoral bypass surgery, making the heparin-bonded graft the only source of heparin in his body at the time of HIT diagnosis. The patient was treated with argatroban, successfully bridged to warfarin with improvement in platelet counts. Graft explantation was not required. We believe that heparin-bonded grafts have the potential to lead to HIT. However, treatment can be conservative without the need for graft explantation.