Dabigatran, a direct thrombin inhibitor, can be a life-saving treatment in \nheparin-induced thrombocytopenia
A 67-year-old woman with left femoral fracture ward of Shariati Hospital (Isfahan, Iran). She received sufficient thromboprophylaxis with enoxaparin for 6 days and then underwent orthopedic surgery.\nFive days after surgery, the patient experienced swelling, pain, and tenderness in her left thigh and leg. Doppler sonography was ordered to confirm the suspected deep vein thrombosis (DVT). Dilation of the left common femoral, superficial femoral, popliteal, and posterior tibial veins was detected without any blood flow in them and with no compressibility as well. In the other hand some echogenic mass presented in those veins (). DVT in the left lower limb was thus confirmed. Baseline platelet count was 173,000/μL but dropped to 32,000/μL two weeks after the initiation of enoxaparin ().\nBased on clinical history and laboratory findings, the diagnosis of thrombosis associated with HIT was made. Enoxaparin was therefore discontinued immediately and oral dabigatran was administered (110 mg twice a day). A few days later, platelet count increased to the normal range (236,000/μL) and the patient declared improvement in symptoms (). On the tenth day of treatment with dabigatran, Doppler ultrasound was repeated which indicated the recanalization of the thrombosis ().