Evaluating Thrombocytopenia During Heparin Therapy

Yu-Min Shen, Heather Wolfe, Stephen Barman

JAMA. 2018;319(5):497-498. doi:10.1001/jama.2017.21898

Case

A 45-year-old man was hospitalized with abdominal pain. He was diagnosed with superior mesenteric vein thrombosis with mesenteric ischemia and treated with partial small bowel resection and 2 weeks of enoxaparin while hospitalized. Three weeks later, he presented again with abdominal pain. A computed tomography (CT) scan demonstrated fluid collections adjacent to the ascending colon and bowel wall thickening with intestinal pneumatosis consistent with ischemic bowel. Superior mesenteric vein thrombosis was redemonstrated on CT scan. An intravenous course of piperacillin-tazobactam was started, and an exploratory laparotomy with bowel resection was performed. Postoperatively, intravenous heparin was started. One day following surgery, a CT scan demonstrated a new left femoral vein thrombosis and pulmonary embolism. Laboratory data are shown in Table 1.

一名45岁男性患者因腹痛住院。诊断为肠系膜上静脉血栓形成伴肠系膜缺血，在住院期间接受部分小肠切除及为期2州的伊诺肝素治疗。3周后，患者因腹痛再次就诊。CT扫描显示升结肠附近积液，肠壁增厚伴囊样积气，符合肠缺血表现。CT扫描再次发现肠系膜上静脉血栓形成。开始静脉使用哌拉西林-他唑巴坦，并行剖腹探查肠切除术。术后开始静脉使用肝素。术后1天，CT扫描显示新发左侧股静脉血栓形成及肺栓塞。实验室检查见表1。