[Heparin-associated type II thrombocytopenia as a cause of multiple thromboembolism complications].

13 days after hysterectomy and subcutaneous treatment with unfractionated heparin (10000 IU daily) a 68 year old women developed a pulmonary embolism and deep vein thrombosis of the right leg. She thereupon received intravenous heparin (1000 IU/h). Eight days later she developed acute ischaemia of both legs, and Doppler examination revealed acute Leriche's Syndrome with thrombosis of both iliac arteries. Platelet count fell from, initially 152 x 10(9)/I, to 44 x 10(9)/I. Although heparin-associated thrombocytopenia type II was suspected a confirmation by demonstrating a heparin dependent antibody with the heparin-induced platelet activation (HIPA)-test failed and therefore crossreactivity of low molecular heparins or heparinoids could not be assessed. After discontinuation of heparin and iliacal artery thrombectomy a combination therapy with aspirin plus ticlopidine (500 mg/d respectively) was started and continued until phenprocoumon could exert its full effect. No recurrent thromboembolic events occurred, the platelet counts normalized and the patient fully recovered.