Saddle pulmonary embolism and heparin-induced thrombocytopenia in acute pancreatitis: a case report

Acute pancreatitis causes severe inflammation, predisposing patients to thromboembolism, which can be further complicated by heparin-induced thrombocytopenia and thrombosis (HITT). A 47-year-old diabetic male patient with severe acute pancreatitis developed a massive saddle pulmonary embolism. Low-molecular-weight heparin (LMWH) treatment triggered a deep vein thrombosis, and a severe platelet drop (28 × 109/l), confirming HITT. Due to a refractory response to fondaparinux, the patient was successfully switched to direct oral anticoagulation with dabigatran etexilate (150 mg twice daily). This led to rapid platelet normalization and clinical stability. When standard parenteral treatments fail in HITT, direct oral anticoagulants like dabigatran offer an effective alternative strategy.