Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#21 DANAPRANOID SYSTEMIC ANTICOAGULATION FOR SYMPTOMATIC CAROTID ENDARTERECTOMY IN A PATIENT WITH TROUSSEAU'S SYNDROME AND HITT
E. John Harris, Jr., M.D.
Stanford University Stanford, CA
A 73-year-old woman with adult onset diabetes mellitus and hypertension was diagnosed with Stage IIIb adenocarcinoma of the lung 11 months prior to presentation. She was treated with chemotherapy but developed left leg deep vein thrombosis (DVT) 7 months prior to presentation, anticoagulated with heparin and warfarin and discharged. One month later, she developed recurrent DVT, with an INR of 3.0. Readmitted and heparinized, she developed heparin-induced thrombocytopenia with worsening thrombosis (HITT). Vena caval filter placed, heparin discontinued, and she cross-reacted with LMWH. Transferred to our institution for catheter-directed thrombolysis and started on Danapranoid sodium. Urokinase infusion split between popliteal and femoral vein slit hole catheters was successful in lysing the thrombus after 14 hours and iliac vein angioplasty, with stent, was performed. Recurrent thrombus developed in caval filter after 24 hours, urokinase re-infused with lysis completed, and the Danapranoid dose was increased to maintain and anti-XA level of 0.8-1.0 units/ml. Did well on BID dose of Danapranoid for 5 months, then developed 3 episodes of right eye amaurosis fugax. A carotid duplex showed a 90-99% stenosis of the right carotid artery. The patient was maintained on full dose Danapranoid, taken to the OR and carotid dissection was completed. Prior to clamping the carotid, an additional dose of Danapranoid was given IV, and Danapranoid was used in normal saline for irrigation. Carotid endarterectomy was completed with primary closure. There were no perioperative or postoperative hemorrhagic or thrombotic complications.
Conclusion: Danapranoid sodium is a new agent available for systemic anticoagulation, a case report outlines its use.
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Last updated January 10, 1999