Heparin-induced thrombocytopenia with arterial thrombosis: an unusual case

A case of heparin-induced thrombocytopenia with thrombosis (HITT) is described. The patient, treated for several days with porcine Ca-heparin at a dosage of 10,000 IU/day, presented severe thrombocytopenia (Plt 36 x 10(9)/L), intermittent right leg ischemia, and a positive heparin-induced platelet aggregation assay. We promptly discontinued heparin and started picotamide, an antiplatelet drug. Rapid clinical improvement was observed in a few days. We stress the unusual features of the reported case (HITT during prophylactic therapy with low doses of porcine heparin; intermittent thrombosis), and we suggest picotamide represents a rational therapy for HITT on the basis of clinical and pathogenetic considerations.