Arterial thromboembolism is a recognized complication of systemic
heparin therapy. Characteristic of the entity is arterial occlusion by
platelet-fibrin thrombi with distal ischemia occurring four to twenty days
after the initiation of heparin therapy, preceded by profound
thrombocytopenia with platelet counts in the range of 30,000 to 40,000 per
cubic millimeter. The clinically apparent occlusion may be preceded by
gastrointestinal and musculoskeletal symptoms that appear to be ischemic in
origin, and might serve to warn the clinician of these complications.
Previous reports of these phenomena as well as recent studies of the effect
of heparin are reviewed. The common factor relating thromboembolism and
thrombocytopenia is heparin-induced platelet aggregation. Appropriate
treatment consists of discontinuation of heparin, and anticoagulation with
sodium warfarin if necessary. Vascular procedures are performed as
indicated.