对于患有肝素相关抗血小板抗体的患者，水蛭素是一种安全有效的抗凝剂。

Mudaliar J H, Liem T K, Nichols W K, Spadone D P, Silver D

Division of Vascular Surgery, Department of Surgery, University of Missouri Health Care, Columbia, USA.

J Vasc Surg. 2001 Jul;34(1):17-20. doi: 10.1067/mva.2001.115602.

OBJECTIVE

The purpose of this study was to determine whether lepirudin, a direct thrombin inhibitor, is a safe and effective anticoagulant for patients with heparin-associated antiplatelet antibodies (HAAbs).

METHODS

The charts of HAAb-positive patients who received lepirudin were reviewed. Lepirudin use was analyzed for indication, duration, and effectiveness of anticoagulation, and for adverse events. HAAb presence was determined by platelet aggregation.

RESULTS

Eighteen HAAb-positive patients received lepirudin: 9 had previous documentation of HAAb, 6 had thrombocytopenia while receiving heparin; and 3 had HAAb after a thrombotic event. The indications for lepirudin anticoagulation included thromboembolism prophylaxis (5), arterial thromboses (5), pulmonary embolus (3) or deep venous thrombosis (1), and one each for atrial fibrillation, myocardial infarction, artificial heart valves, and hemodialysis access. The average duration of therapy was 4.04 days. Fifteen patients achieved adequate anticoagulation (activated partial thromboplastin time [aPTT] ratio > 2.0) with lepirudin. Seven patients had aPTTs that were sometimes supratherapeutic (aPTT > 100 seconds) but did not bleed. In all patients who had heparin-induced thrombocytopenia, platelet counts were normalized while they received lepirudin. There were two complications: one patient fell and had a calf hematoma (aPTT ratio 3.24), and one patient who received lepirudin during nine separate hospitalizations had epistaxis (aPTT ratio 2.86) during her ninth hospitalization. Another patient received lepirudin during two hospitalizations without an adverse event.

CONCLUSION

Lepirudin is a safe and effective anticoagulant for patients with HAAbs. The platelet counts of all patients with heparin-induced thrombocytopenia were normalized while they received lepirudin. Careful monitoring of the aPTT and avoidance of trauma while patients are receiving lepirudin are recommended.

目的

本研究旨在确定直接凝血酶抑制剂来匹卢定对肝素相关抗血小板抗体（HAAbs）患者是否为一种安全有效的抗凝剂。

方法

回顾了接受来匹卢定治疗的HAAb阳性患者的病历。分析了来匹卢定的使用情况，包括抗凝的指征、持续时间和有效性以及不良事件。通过血小板聚集测定HAAb的存在情况。

结果

18例HAAb阳性患者接受了来匹卢定治疗：9例既往有HAAb记录，6例在接受肝素治疗时出现血小板减少；3例在血栓形成事件后出现HAAb。来匹卢定抗凝的指征包括预防血栓栓塞（5例）、动脉血栓形成（5例）、肺栓塞（3例）或深静脉血栓形成（1例），以及心房颤动、心肌梗死、人工心脏瓣膜和血液透析通路各1例。平均治疗持续时间为4.04天。15例患者使用来匹卢定达到了充分抗凝（活化部分凝血活酶时间[aPTT]比值>2.0）。7例患者的aPTT有时超过治疗范围（aPTT>100秒）但未出血。在所有肝素诱导的血小板减少症患者中，接受来匹卢定治疗期间血小板计数恢复正常。有2例并发症：1例患者跌倒并出现小腿血肿（aPTT比值3.24），1例在9次不同住院期间接受来匹卢定治疗的患者在第9次住院期间出现鼻出血（aPTT比值2.86）。另1例患者在2次住院期间接受来匹卢定治疗未发生不良事件。