{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:36Z","timestamp":1790982996574,"version":"4.1.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TH Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Heparin-induced thrombocytopenia (HIT) with thrombosis typically necessitates immediate therapeutic-dose anticoagulation, yet management becomes exceedingly complex when a profound bleeding risk coexists. We report a unique case of serologically confirmed HIT developing during low-molecular-weight heparin prophylaxis following major trauma in a 67-year-old man. On day 10 of heparin exposure, the patient presented with a platelet count declining from 169 \u00d7 109\/L to 20 \u00d7 109\/L (91% reduction), hypofibrinogenemia (1.12 g\/L), extensive deep vein thrombosis, and pulmonary embolism. Owing to extreme bleeding risk, argatroban initiation was deferred for 48 hours postdiagnosis, then cautiously titrated from 0.08 to 0.67 \u03bcg\/kg\/min guided by dynamic coagulation\u2013fibrinolysis markers (thrombin\u2013antithrombin complex, plasmin\u2013\u03b12-antiplasmin complex, and D-dimer). These markers provided real-time assessment of treatment response, declining substantially prior to platelet count normalization. By day 12 postdiagnosis, platelet count recovered to 176 \u00d7 109\/L, permitting successful definitive orthopedic surgery on day 13 without bleeding complications. This case illustrates that in HIT with life-threatening thrombosis and extreme bleeding risk, an individualized \u201cstart low, go slow\u201d argatroban strategy with delayed initiation achieves effective anticoagulation while minimizing hemorrhagic risk.<\/jats:p>","DOI":"10.1055\/a-2923-1469","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:43:06Z","timestamp":1784940186000},"source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["Ultra-Low Dose Argatroban in Heparin-Induced Thrombocytopenia with Thrombocytopenia and Hypofibrinogenemia: A Case Report"],"prefix":"10.1055","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3583-9169","authenticated-orcid":false,"given":"Chunqian","family":"Shi","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Cai","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Yue","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Ma","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingfen","family":"Qin","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Song","sequence":"additional","affiliation":[{"name":"North China Medical and Health Group Xingtai General Hospital, Hebei Province, China","place":["Xingtai"],"department":["Department of Clinical Laboratory"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"21","key":"ref1","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1182\/blood-2016-11-709873","article-title":"Heparin-induced thrombocytopenia","volume":"129","author":"G M Arepally","year":"2017","journal-title":"Blood"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/1358863X19898253","article-title":"Heparin-induced thrombocytopenia (HIT): review of incidence, diagnosis, and management","volume":"25","author":"M Hogan","year":"2020","journal-title":"Vasc Med"},{"issue":"01","key":"ref3","first-page":"132","article-title":"Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis. A retrospective analysis of 408 patients","volume":"94","author":"A Greinacher","year":"2005","journal-title":"Thromb Haemost"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1046\/j.1365-2141.2003.04334.x","article-title":"Heparin-induced thrombocytopenia: pathogenesis and management","volume":"121","author":"T E Warkentin","year":"2003","journal-title":"Br J Haematol"},{"issue":"22","key":"ref5","doi-asserted-by":"crossref","first-page":"3360","DOI":"10.1182\/bloodadvances.2018024489","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia","volume":"2","author":"A Cuker","year":"2018","journal-title":"Blood Adv"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1097\/01.CCM.0000259538.02375.A5","article-title":"Heparin-induced thrombocytopenia in intensive care patients","volume":"35","author":"K Selleng","year":"2007","journal-title":"Crit Care Med"},{"issue":"20","key":"ref7","doi-asserted-by":"crossref","first-page":"4160","DOI":"10.1182\/blood-2012-07-443051","article-title":"Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis","volume":"120","author":"A Cuker","year":"2012","journal-title":"Blood"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"R90","DOI":"10.1186\/cc9024","article-title":"Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study","volume":"14","author":"B Saugel","year":"2010","journal-title":"Crit Care"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"e22913","DOI":"10.1002\/jcla.22913","article-title":"Performance evaluation of thrombomodulin, thrombin-antithrombin complex, plasmin-\u03b12-antiplasmin complex, and t-PA: PAI-1 complex","volume":"33","author":"Q Chen","year":"2019","journal-title":"J Clin Lab Anal"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1186\/s12891-022-05532-1","article-title":"Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty","volume":"23","author":"Z Lin","year":"2022","journal-title":"BMC Musculoskelet Disord"}],"container-title":["TH Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2923-1469.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:48:54Z","timestamp":1786495734000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2923-1469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":10,"journal-issue":{"issue":"CP","published-online":{"date-parts":[[2026,1,9]]},"published-print":{"date-parts":[[2026]]}},"alternative-id":["a29231469"],"URL":"https:\/\/doi.org\/10.1055\/a-2923-1469","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2512-9465"],"issn-type":[{"value":"2512-9465","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7,24]]},"published":{"date-parts":[[2026,7,24]]}}}