Bircher A J, Harr T, Hohenstein L, Tsakiris D A
Allergy Unit, University Hospital, Basel, Switzerland.
Allergy. 2006 Dec;61(12):1432-40. doi: 10.1111/j.1398-9995.2006.01227.x.
Anticoagulants, including heparins, coumarins, hirudins, and some of the previously used plasma volume expanders, belong to the most widely used drugs. Hypersensitivity reactions from these agents are uncommon. However, they may have a considerable impact on patient safety and treatment decisions. Therefore, early diagnosis of potentially life-threatening adverse events and identification of alternatives is clinically important. This review contains an update on current knowledge about hypersensitivity reactions caused by the different anticoagulants. In addition, it discusses pathophysiologic mechanisms, diagnostic possibilities, and management options. The most common hypersensitivity reactions are erythematous plaques, occurring with a delay after subcutaneous application of heparins. Seldom they turn into maculopapular exanthema. Other hypersensitivity reactions are rare but may be life-threatening, e.g. skin necrosis because of heparin-induced thrombocytopenia. Skin and provocation tests with immediate and late readings are the most reliable diagnostic tools for heparin- or hirudin-induced urticaria/anaphylaxis or heparin-induced delayed plaques. If necrosis from heparins or coumarins is suspected, skin tests are contraindicated. In anaphylactic reactions caused by dextrans or hydroxyethyl starch skin tests are useless. Most in vitro tests have a low sensitivity and are not generally available. Therefore, in some anticoagulant-associated hypersensitivity reactions detailed allergologic investigation may help to identify safe treatment alternatives. However, several tests may be needed, and the procedures are usually time-consuming.
抗凝剂，包括肝素、香豆素、水蛭素以及一些以前使用的血浆容量扩充剂，属于使用最为广泛的药物。这些药物引起的过敏反应并不常见。然而，它们可能对患者安全和治疗决策产生重大影响。因此，早期诊断潜在的危及生命的不良事件并确定替代药物在临床上具有重要意义。本综述包含了关于不同抗凝剂引起的过敏反应的最新知识。此外，还讨论了病理生理机制、诊断方法和管理方案。最常见的过敏反应是红斑性斑块，在皮下注射肝素后延迟出现。很少会发展为斑丘疹性皮疹。其他过敏反应虽罕见但可能危及生命，例如肝素诱导的血小板减少症导致的皮肤坏死。皮肤试验和激发试验以及即时和延迟读数是诊断肝素或水蛭素诱导的荨麻疹/过敏反应或肝素诱导的延迟性斑块最可靠的工具。如果怀疑肝素或香豆素引起坏死，则禁忌进行皮肤试验。在右旋糖酐或羟乙基淀粉引起的过敏反应中，皮肤试验毫无用处。大多数体外试验敏感性较低且一般无法进行。因此，在一些与抗凝剂相关的过敏反应中，详细的变态反应学检查可能有助于确定安全的替代治疗方法。然而，可能需要进行多项检查，而且这些程序通常很耗时。
