Lubenow Norbert, Selleng Sixten, Wollert Hans-Georg, Eichler Petra, Müllejans Bernd, Greinacher Andreas
Institute of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany.
Ann Thorac Surg. 2003 Feb;75(2):577-9. doi: 10.1016/s0003-4975(02)04309-6.
Heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy, mandates heparin cessation and alternative anticoagulation. We report a patient with a history of HIT who successfully underwent cardiopulmonary bypass (CPB) using short-term reexposure to heparin and perioperative therapy with argatroban. No bleeding complications or HIT-related problems occurred. The pharmacokinetics of argatroban, especially its hepatic rather than renal elimination, makes it the drug of choice for some HIT patients in whom other alternative anticoagulants (eg, danaparoid and hirudin) are less well suited. Because of interference with the international normalized ratio (INR), switching from argatroban to oral anticoagulants is not straightforward.
肝素诱导的血小板减少症（HIT）是肝素治疗的一种严重并发症，需要停用肝素并采用替代抗凝治疗。我们报告了一名有HIT病史的患者，该患者成功接受了体外循环（CPB），期间短期再次使用肝素，并在围手术期使用阿加曲班治疗。未发生出血并发症或与HIT相关的问题。阿加曲班的药代动力学，尤其是其通过肝脏而非肾脏清除的特性，使其成为一些其他替代抗凝剂（如达那肝素和水蛭素）不太适用的HIT患者的首选药物。由于对国际标准化比值（INR）有干扰，从阿加曲班转换为口服抗凝剂并非易事。
