Warkentin Theodore E, Greinacher Andreas
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Ann Thorac Surg. 2003 Aug;76(2):638-48. doi: 10.1016/s0003-4975(03)00756-2.
Unfractionated heparin given during cardiopulmonary bypass is remarkably immunogenic, as 25% to 50% of postcardiac surgery patients develop heparin-dependent antibodies during the next 5 to 10 days. Sometimes, these antibodies strongly activate platelets and coagulation, thereby causing the prothrombotic disorder, heparin-induced thrombocytopenia. The risk of heparin-induced thrombocytopenia is 1% to 3% if unfractionated heparin is continued throughout the postoperative period. When cardiac surgery is urgently needed for a patient with acute or subacute heparin-induced thrombocytopenia, options include an alternative anticoagulant (bivalirudin, lepirudin, or danaparoid) or combining unfractionated heparin with a platelet antagonist (epoprostenol or tirofiban). As heparin-induced thrombocytopenia antibodies are transient, unfractionated heparin alone is appropriate in a patient with previous heparin-induced thrombocytopenia whose antibodies have disappeared.
在体外循环期间给予的普通肝素具有显著的免疫原性，因为25%至50%的心脏手术后患者在接下来的5至10天内会产生肝素依赖性抗体。有时，这些抗体强烈激活血小板和凝血，从而导致血栓前状态，即肝素诱导的血小板减少症。如果在术后整个期间持续使用普通肝素，肝素诱导的血小板减少症的风险为1%至3%。当急性或亚急性肝素诱导的血小板减少症患者急需进行心脏手术时，可以选择替代抗凝剂（比伐卢定、重组水蛭素或达那肝素），或者将普通肝素与血小板拮抗剂（依前列醇或替罗非班）联合使用。由于肝素诱导的血小板减少症抗体是短暂的，对于先前患有肝素诱导的血小板减少症且抗体已消失的患者，单独使用普通肝素是合适的。
