Unusual presentation of heparin-induced thrombocytopenia and thrombosis (HITT) with multiple organ involvement

In this case, a woman in her 60s was diagnosed with heparin-induced thrombocytopenia (HIT) following the use of prophylactic enoxaparin postoperatively. Subsequently, she developed bilateral pulmonary emboli (PE), hepatic vein thrombosis and bilateral adrenal infarcts. On initiating warfarin therapy, she developed right leg deep vein thrombosis (DVT). She was successfully bridged onto warfarin with an argatroban infusion and has not developed any further thrombosis since being discharged on warfarin single-agent treatment. Her care required a multidisciplinary approach involving input from specialist haematologists at the local tertiary centre as well as endocrinologists, gastroenterologists, respiratory physicians and orthogeriatricians. This report serves as a key reminder of the many complications of HIT. Additionally, it reminds us to consider the paradoxical procoagulant state seen in early warfarinisation and the potential consequences of this.