Smythe Maureen A, Warkentin Theodore E, Stephens Jennifer L, Zakalik Dana, Mattson Joan C
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, Michigan 48073-6769, USA.
Am J Hematol. 2002 Sep;71(1):50-2. doi: 10.1002/ajh.10181.
We report two patients with deep-vein thrombosis complicating immune heparin-induced thrombocytopenia who developed venous limb gangrene during overlapping therapy with a direct thrombin inhibitor (lepirudin or argatroban) and warfarin. In both patients, therapy with the direct thrombin inhibitor was interrupted during persisting severe athrombocytopenia while warfarin administration continued. Both patients exhibited the typical feature of a supratherapeutic international normalized ratio (INRs, 5.9 and 7.3) that has been linked previously with warfarin-associated venous limb gangrene. These data suggest that warfarin anticoagulation be postponed in patients with acute heparin-induced thrombocytopenia until substantial recovery of the platelet count has occurred.
我们报告了两名患有深部静脉血栓形成并伴有免疫性肝素诱导的血小板减少症的患者，他们在直接凝血酶抑制剂（比伐卢定或阿加曲班）与华法林的重叠治疗期间发生了肢体静脉坏疽。在这两名患者中，在严重血小板减少症持续存在时中断了直接凝血酶抑制剂的治疗，而华法林的给药仍在继续。两名患者均表现出国际标准化比值（INR）超治疗范围的典型特征（分别为5.9和7.3），这一特征先前已与华法林相关的肢体静脉坏疽有关。这些数据表明，对于急性肝素诱导的血小板减少症患者，应推迟华法林抗凝治疗，直到血小板计数大幅恢复。
