Ishibashi H, Takashi O, Hosaka M, Sugimoto I, Takahashi M, Nihei T, Kawanishi J, Ishiguchi T
Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
Int Angiol. 2005 Dec;24(4):387-90.
A 45-year-old man presented with deep vein thrombosis of the right leg and bilateral pulmonary embolism. Heparin was administered on the initial one and a half days. On the 3rd day, an inferior vena cava (IVC) filter was placed with a heparin flush, after which massive IVC thrombosis developed. The platelet count was 221000/mm3, decreased 42% from the initial level, but remained within the normal range. Heparin was replaced by argatroban on the 13th day. The platelet count increased to 355000/mm3 on the 15th day. The patient was positive for antibody against complexes of heparin and platelet factor 4, and was diagnosed as heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). When thrombosis develops during heparin treatment, it is important to suspect HITTs and to assay for the associated antibodies, regardless of the actual platelet count.
一名45岁男性患者出现右下肢深静脉血栓形成及双侧肺栓塞。最初的一天半给予肝素治疗。第3天，在下腔静脉（IVC）置入滤器并给予肝素冲洗，之后发生了大量下腔静脉血栓形成。血小板计数为221000/mm³，较初始水平下降了42%，但仍在正常范围内。第13天肝素被阿加曲班替代。第15天血小板计数升至355000/mm³。该患者针对肝素与血小板因子4复合物的抗体呈阳性，被诊断为肝素诱导的血小板减少伴血栓形成综合征（HITTS）。在肝素治疗期间发生血栓形成时，无论实际血小板计数如何，怀疑HITTS并检测相关抗体都很重要。
