Gruel Y, Lermusiaux P, Lang M, Darnige L, Rupin A, Delahousse B, Guilmot J L, Leroy J
Laboratoire d'Hématologie, Service de Chirurgie Cardiovasculaire, Centre Hospitalier Universitaire, Tours, France.
Ann Vasc Surg. 1991 Nov;5(6):552-5. doi: 10.1007/BF02015283.
Heparin-associated thrombocytopenia and thrombosis is a severe complication of systemic heparin therapy. Its treatment is mainly based upon discontinuation of heparin therapy. However in some patients requiring emergency cardiac or vascular surgery, reexposure to heparin may be unavoidable. We report the management of two such patients by use of antiplatelet drugs for a vascular procedure. In the two cases, a combination of iloprost, a stable prostacyclin analogue (1 to 2 ng/kg/mn) with aspirin and dipyridamole was shown to inhibit ex vivo the heparin-induced platelet aggregation. These antiplatelet agents were continued during the perioperative period. A successful vascular procedure was achieved with full heparinization without subsequent thrombocytopenia or thrombotic or hemorrhagic complications. This experience supports the hypothesis that heparin can be readministered early to patients with heparin-associated thrombocytopenia and thrombosis, provided antiplatelet therapy is given.
肝素相关性血小板减少症和血栓形成是全身性肝素治疗的严重并发症。其治疗主要基于停用肝素治疗。然而，在一些需要进行急诊心脏或血管手术的患者中，再次使用肝素可能不可避免。我们报告了通过使用抗血小板药物进行血管手术对两名此类患者的处理情况。在这两个病例中，一种稳定的前列环素类似物伊洛前列素（1至2纳克/千克/分钟）与阿司匹林和双嘧达莫联合使用，显示出在体外可抑制肝素诱导的血小板聚集。这些抗血小板药物在围手术期持续使用。在充分肝素化的情况下成功完成了血管手术，术后未出现血小板减少、血栓形成或出血并发症。这一经验支持了这样的假设，即对于肝素相关性血小板减少症和血栓形成的患者，只要给予抗血小板治疗，就可以早期重新使用肝素。
