Grubb Kendra J, Salehi Payam, Chedrawy Edgar G
Division of Cardiothoracic Surgery, Department of Surgery, L. Weiss Memorial Hospital, University of Illinois, College of Medicine, Chicago, Illinois, USA.
Recent Pat Cardiovasc Drug Discov. 2010 Jan;5(1):20-4. doi: 10.2174/157489010790192674.
An estimated 1-3% of patients who receive therapeutic anticoagulation with unfractionated heparin (UFH) develop antibodies to heparin with concomitant development of thrombocytopenia, defined as HIT or Heparin-Induced Thrombocytopenia. HIT complicates the management of patients presenting for cardiac surgery, particularly those who need cardiopulmonary bypass (CPB) which requires a large dose of UFH. A portion of these patients will have significant thrombotic complications referred to as HITT (Heparin-induced thrombocytopenia with thrombosis). In patients with established or suspected HIT, all heparin must be withheld and an alternative form of anticoagulation utilized for CPB. Various approaches and pharmacological alternatives have been described but no regimen has replaced the routine use of UFH anticoagulation with protamine reversal after CPB. We review the use of bivalirudin as a reliable and safe alternative anticoagulation strategy during cardiopulmonary bypass with specific emphasis on patients with HIT and outlining some recent patents.
估计有1%至3%接受普通肝素（UFH）治疗性抗凝的患者会产生肝素抗体，并伴随血小板减少，这被定义为肝素诱导的血小板减少症（HIT）。HIT会使心脏手术患者的管理变得复杂，尤其是那些需要体外循环（CPB）的患者，而CPB需要大剂量的UFH。这些患者中的一部分会出现严重的血栓并发症，称为肝素诱导的血小板减少症伴血栓形成（HITT）。对于已确诊或疑似HIT的患者，必须停用所有肝素，并在CPB时采用替代抗凝方式。已经描述了各种方法和药理学替代方案，但没有任何方案能够取代CPB后使用鱼精蛋白逆转的UFH常规抗凝方法。我们回顾了比伐卢定在体外循环期间作为一种可靠且安全的替代抗凝策略的应用，特别强调了HIT患者，并概述了一些近期的专利。
