摘要
目的提高对肝素诱导血小板减少症(heparin-induced thrombocytopenia,HIT)的诊断水平及认识,减少临床误诊误治。方法对1例低分子肝素诱导HIT患者临床资料进行回顾性分析,并结合文献进行分析。结果患者患有急性下壁右室心肌梗死,行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后常规予阿司匹林、替格瑞洛、依替巴肽及低分子肝素治疗。术后15 d出现广泛周围静脉血栓形成,抗凝治疗改为氯吡格雷75 mg每日1次口服联合低分子肝素4000 U每12 h 1次皮下注射,后出现右侧枕叶出血,2 d后血小板急剧下降超过50%,根据4Ts评分标准诊断为Ⅱ型HIT,更换抗凝药物为磺达肝葵钠和(或)达比加群酯治疗后,血小板逐步回升,7个月后恢复正常。结论 HIT少见且部分发病隐匿,对于使用肝素类制剂抗凝治疗后出现血小板减少患者需高度警惕HIT,及早行临床评估及相关实验室检查,以及早确诊并治疗。
Objective To improve the diagnosis and awareness of heparin-induced thrombocytopenia （HIT） in order to avoid misdiagnosis and mistreatment. Methods Clinical data of a patient with low molecular HIT was retrospectively analyzed, and relative literature was reviewed. Results The patient with acute inferior Wall right ventricular myocardial infarction received Aspirin, Ticagrelor, Eptifibatide and low molecular heparin treatments after undergoing percutaneous coronary inter- vention （PCI）. Widely peripheral venous thrombosis was found on postoperative 15 days. Anticoagulation treatment was changed to 75 mg Clopidogrel with once daily by orally and 4000 U low molecular heparin by one time for every 12 h by subcu- taneous injections, and then right occipital hemorrhage was found, and platelet count was rapidly decreased more than 50% 2 days later. The patient was diagnosed as having type 11 HIT according to the 4Ts score standard. The platelet count gradually improved when the anticoagulant drugs were changed to Fondaparinux Sodium and （or） Dabigatran ester. The platelet recov- ered to normal 7 months later. Conclusion HIT is rare and latent, so clinicians should highly suspect HIT for patients with decreasing platelet count after anticoagulant treatment with containing heparin drugs. Clinical evaluation and medical examinations should be performed early so as to confirm diagnosis and treatment as early as possible.
作者
程京华
闵煜榕
彭永平
宫剑滨
CHENG Jing-hua MIN Yu-rong PENG Yong-ping GONG Jian-bin(Department of Cardiology, Nanjing General Hospital of Nanjing Military Area Command, Nanjing 210002, China)
出处
《临床误诊误治》
2017年第1期69-72,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肝素
药物毒性
血小板减少
静脉血栓形成
脑出血
Heparin
Drug toxicity
Thrombocytopenia
Venous thrombosis
Cerebral hemorrhage
