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Lower Limb Paralysis as Initial Presentation of Arterial Embolism Secondary to Heparin-Induced Thrombocytopenia after Hip Fracture - a Case Report.

Introduction: Prophylactic anticoagulation (AC) with low molecular weight heparins (LMWHs) following hip fracture has reduced the incidence of severe thromboembolic events. However, heparin-induced thrombocytopenia (HIT) remains a serious complication in these patients. Clinical case: We report an unusual case of thrombosis due to severe HIT in a 75-year-old female patient following intramedullary nailing for a hip fracture. The patient was taking Verapamine. On the fourth postoperative day she developed paralysis, paresthesia and mild pain over the right lower extremity; faint pulses were palpated. Computed tomography angiogram identified superficial artery occlusion leading to limb ischemia. Anti-platelet factor 4 (PF4) heparin antibody positivity confirmed the diagnosis of HIT. Urgent embolectomy was performed and the patient achieved full recovery. Discussion: Arterial embolism presenting with severe neurological deficits is a rare complication of HIT. Conclusion:A high index of suspicion and close platelet count monitoring is warranted for early diagnosis and treatment of this devastating condition that can be limb and life threatening.