Nitta Naoki, Shitara Satoshi, Nozaki Kazuhiko
Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan.
Neurol Med Chir (Tokyo). 2011;51(6):445-8. doi: 10.2176/nmc.51.445.
A 58-year-old woman presented with right supplementary motor area glioblastoma multiforme and deep venous thrombosis in her legs. The tumor was resected after temporary inferior vena cava filter placement, considering that increased thrombosis during and after the operation would cause fatal pulmonary embolism. After anticoagulation with unfractionated heparin, thrombocytopenia was aggravated, and computed tomography showed filter catheter-related thrombosis in the inferior vena cava. The diagnosis was heparin-induced thrombocytopenia, and argatroban and urokinase were administered. Thrombolysis with urokinase was completed and the temporary inferior vena cava filter catheter was removed without complication. The present case illustrates the possibility of heparin-induced thrombocytopenia associated with catheter-related thrombosis in neurosurgery.
一名58岁女性患有右辅助运动区多形性胶质母细胞瘤，并伴有双下肢深静脉血栓形成。考虑到手术期间及术后血栓形成增加会导致致命的肺栓塞，在临时放置下腔静脉滤器后对肿瘤进行了切除。使用普通肝素抗凝后，血小板减少加重，计算机断层扫描显示下腔静脉存在滤器导管相关血栓形成。诊断为肝素诱导的血小板减少症，给予阿加曲班和尿激酶治疗。尿激酶溶栓完成，临时下腔静脉滤器导管顺利取出，无并发症发生。本病例说明了神经外科手术中肝素诱导的血小板减少症与导管相关血栓形成的可能性。
