Riess Friedrich-Christian
Albertinen Heart Center, Suentelstrasse 11 a, 22457 Hamburg, Germany.
Semin Thorac Cardiovasc Surg. 2005 Spring;17(1):85-96. doi: 10.1053/j.semtcvs.2004.12.008.
Unfractionated heparin (UFH) is the gold standard for anticoagulation during cardiopulmonary bypass (CPB). Of patients undergoing CPB operations, 25% to 50% develop heparin-dependent antibodies during the postoperative period, typically between day 5 and 10, if UFH is continued during the postoperative course. In 1% to 3% of all patients undergoing CPB operation with UFH anticoagulation, these antibodies activate platelets causing a prothrombotic disorder, known as heparin-induced thrombocytopenia (HIT), which can lead to life-threatening thromboembolic complications. If urgent cardiac operation with the use of CPB in patients with positive antibody titer is required, different anticoagulatory approaches are available, such as lepirudin, bivalirudin, and danaparoid or UFH in combination with platelet antagonists, such as epoprostenol or tirofiban. In patients with previous HIT but no detectable antibodies, UFH alone can be used only during CPB, but alternative anticoagulation has to be used pre- and postoperatively.
普通肝素（UFH）是体外循环（CPB）期间抗凝的金标准。在接受CPB手术的患者中，如果术后继续使用UFH，25%至50%的患者会在术后期间，通常是在第5天至第10天产生肝素依赖性抗体。在所有接受UFH抗凝的CPB手术患者中，1%至3%的患者体内这些抗体激活血小板，导致一种血栓前状态紊乱，称为肝素诱导的血小板减少症（HIT），这可能会导致危及生命的血栓栓塞并发症。如果抗体滴度呈阳性的患者需要使用CPB进行紧急心脏手术，可以采用不同的抗凝方法，如重组水蛭素、比伐卢定和达那肝素，或者UFH与血小板拮抗剂（如依前列醇或替罗非班）联合使用。对于既往有HIT但未检测到抗体的患者，仅在CPB期间可单独使用UFH，但术前和术后必须采用替代抗凝方法。
