Dickinson Brian P, De Ugarte Daniel A, Reil Todd D, Beseth Bryce D, Lawrence Peter F
University of California Los Angeles Division of Vascular Surgery, Gonda Goldschmied Vascular Center, Los Angeles, CA 90095, USA.
Vasc Endovascular Surg. 2006 Mar-Apr;40(2):161-4. doi: 10.1177/153857440604000212.
Heparin use, both prophylactically and therapeutically, is prevalent among hospitalized patients. Patients on heparin may develop a thrombocytopenia that is self-limited. Fewer patients develop a heparin-induced thrombocytopenia that can cause severe bleeding and thrombosis owing to intravascular platelet aggregation. The authors present a case report of heparin-induced thrombocytopenia in a patient who underwent aortic arch and aortic valve replacement that resulted in bilateral above-knee amputations. The patient developed limb ischemia related to heparin-associated thrombosis, but had a delay in antibody seroconversion. Early and accurate diagnosis of heparin-induced thrombocytopenia requires a high clinical suspicion and may be present despite the absence of serum antibodies.
肝素的预防性和治疗性使用在住院患者中很普遍。使用肝素的患者可能会出现自限性血小板减少症。较少患者会发生肝素诱导的血小板减少症，这种情况可因血管内血小板聚集而导致严重出血和血栓形成。作者报告了一例肝素诱导的血小板减少症病例，该患者接受了主动脉弓和主动脉瓣置换术，结果导致双侧膝上截肢。患者出现了与肝素相关血栓形成有关的肢体缺血，但抗体血清转化延迟。肝素诱导的血小板减少症的早期准确诊断需要高度的临床怀疑，即使没有血清抗体也可能存在该病症。
