Gruel Yves, Regina Sandra, Pouplard Claire
Service d'hématologie-hémostase, hôpital Trousseau, centre hospitalier universitaire de Tours, 37044 Tours, France.
Rev Prat. 2006 Apr 15;56(7):710-8.
Heparin-induced thrombocytopenia (HIT) is due to IgG antibodies specific to platelet factor 4. HIT is characterized by a delayed decrease in platelet count (after the 5th day of treatment) often associated with thromboses. The presence of heparin-dependent antibodies has to be demonstrated to confirm HIT by ELISA or platelet activation tests. Withdrawal of heparin is always necessary, as well as the administration of an alternative antithrombotic agent. Danaparoid sodium or lepirudin are both recommended but associated with a significant risk of bleeding in case of renal failure. Oral anticoagulants can only be given when platelet count is corrected and if the clinical evolution is favorable. Early administration of coumadin for the treatment of venous thromboembolic disease efficiently prevents HIT, which could disappear in the future with the wider use of new antithrombotic agents such as fondaparinux or direct anti-thrombin agents.
肝素诱导的血小板减少症（HIT）是由针对血小板因子4的IgG抗体引起的。HIT的特征是血小板计数延迟下降（治疗第5天后），常伴有血栓形成。必须通过ELISA或血小板活化试验证明存在肝素依赖性抗体以确诊HIT。停用肝素总是必要的，同时还需给予替代抗血栓药物。推荐使用达那肝素钠或比伐卢定，但在肾衰竭时会有显著出血风险。只有当血小板计数恢复正常且临床进展良好时才能给予口服抗凝剂。早期给予香豆素治疗静脉血栓栓塞性疾病可有效预防HIT，随着新型抗血栓药物如磺达肝癸钠或直接抗凝血酶药物的更广泛使用，HIT将来可能会消失。
