A Case of Argatroban Refractory Heparin Induced Thrombocytopenia and Thrombosis

Prophylaxis for deep vein thrombosis is a standard of care for most hospitalized patients. This is typically given in the form of chemical prophylaxis by either, unfractionated heparin or low molecular weight heparin. One complication of administration, besides bleeding, is heparin induced thrombocytopenia (HIT). Of patients receiving therapeutic anticoagulation with heparin an estimated, .5%-1% will go on to develop heparin induced thrombocytopenia.(1) We will present a case of argatroban refractory HIT after a coronary artery bypass grafting resulting in a massive left ventricular thrombus and death. There is a paucity of literature on the topic of argatroban refractory HIT. When it is discussed, the persistent drop of platelets and ongoing thrombosis, despite argatroban therapy, appears to be the hallmark. The treatment being used in these rare cases is intravenous immunoglobulin. Our case sheds light on the existence of this entity and helps consolidate some literature on the topic.