Reilly M P, Weiss R, Askenase A, Tuite C, Soulen M, Mohler E R
Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia, USA.
Vasc Med. 2000;5(4):239-42.
Heparin-induced thrombocytopenia (HIT) is the most common drug-related thrombocytopenia. Thromboembolic complications occur in approximately 50% of patients with HIT and result in limb amputation and death in up to 20% and 30% respectively. Because patients with a history of HIT may require future intravenous anticoagulation but have a high-risk of thromboembolism if re-challenged with heparin, alternative therapies are necessary when further anticoagulation is indicated. The use of direct thrombin inhibitors in HIT patients who also require thrombolytic therapy offers unique challenges to anticoagulant monitoring and safety. We present a case of progressive ileofemoral deep venous thrombosis in a patient with a history of HIT in order to review the combined use of hirudin and thrombolysis in this setting.
肝素诱导的血小板减少症（HIT）是最常见的药物相关性血小板减少症。血栓栓塞并发症发生在约50%的HIT患者中，分别导致高达20%和30%的患者肢体截肢和死亡。由于有HIT病史的患者未来可能需要静脉抗凝治疗，但如果再次使用肝素，发生血栓栓塞的风险很高，因此在需要进一步抗凝治疗时，替代疗法是必要的。在同时需要溶栓治疗的HIT患者中使用直接凝血酶抑制剂，给抗凝监测和安全性带来了独特的挑战。我们报告一例有HIT病史患者发生进行性髂股深静脉血栓形成的病例，以回顾水蛭素与溶栓治疗在此情况下的联合应用。
