Liebman Howard A
University of Southern California-Keck School of Medicine, Jane Anne Nohl Division of Hematology, Center for the Study of Blood Diseases, Los Angeles, CA, USA.
Vascular. 2008 Mar-Apr;16 Suppl 1:S71-6.
Heparin is the predominant anticoagulant used in cardiac and vascular surgery. Heparin-induced thrombocytopenia (HIT) is one of the most serious and life-threatening adverse drug reactions associated with heparin use. In addition to the development of thrombocytopenia, HIT is associated with a high risk (40-50%) of thrombotic complications. The pathophysiology of HIT is now well understood and results from the formation of platelet-activating antibodies against the heparin-platelet factor 4 complex (H-PF4) on the platelet surface. The risk of HIT varies significantly depending on the type of heparin (unfractionated heparin greater than low-molecular-weight heparin), duration of heparin use, and patient population (surgery greater than medical). Readily available serologic assays for serum antibodies against H-PF4 allow for rapid confirmation of a clinical diagnosis of HIT. Owing to the high risk of thrombosis associated with HIT, antithrombotic therapy with direct thrombin inhibitors (lepirudin or argatroban) should be started when serologic assays confirm clinical suspicion.
肝素是心脏和血管手术中使用的主要抗凝剂。肝素诱导的血小板减少症（HIT）是与肝素使用相关的最严重且危及生命的药物不良反应之一。除了血小板减少症的发生，HIT还伴有血栓形成并发症的高风险（40%-50%）。现在人们已经很好地理解了HIT的病理生理学，它是由血小板表面针对肝素-血小板因子4复合物（H-PF4）的血小板激活抗体形成所致。HIT的风险因肝素类型（普通肝素高于低分子肝素）、肝素使用时长以及患者群体（手术患者高于内科患者）的不同而有显著差异。针对血清中抗H-PF4抗体的血清学检测方法简便可得，有助于快速确诊HIT临床诊断。由于HIT与血栓形成的高风险相关，当血清学检测证实临床怀疑时，应开始使用直接凝血酶抑制剂（来匹卢定或阿加曲班）进行抗栓治疗。
