Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Hematol. 2011 Sep;18(5):315-22. doi: 10.1097/MOH.0b013e3283497ef2.
Heparin-induced thrombocytopenia (HIT) is a prothrombotic complication of heparin therapy caused by antibodies against platelet factor 4/heparin complexes. Progress in our understanding of HIT has translated to improvements in treatment and patient outcomes. The objective of this review is to examine recent advances and highlight areas of future inquiry in the epidemiology, diagnosis, and management of this potentially fatal disorder.
Risk factors for the development of HIT related to heparin administration are well described. Recent identification of host-related risk factors adds to our understanding of disease epidemiology. The limited specificity of clinical diagnosis and widely used immunologic assays for HIT results in frequent overdiagnosis. Novel clinical decision rules and laboratory assays to improve diagnosis are in development. Fondaparinux, bivalirudin, and desirudin have recently been added to the HIT armamentarium.
Despite these advances, critical issues remain to be addressed. Future research efforts will focus on the identification of novel clinical risk factors and biomarkers that will enable recognition of individuals at greatest risk, optimization of diagnostic strategies and use of currently available therapeutics, and development of new drugs that not only reduce thrombotic complications, but also minimize bleeding risk, are well tolerated in patients with organ dysfunction, and facilitate transition to outpatient therapy.
肝素诱导的血小板减少症（HIT）是肝素治疗引起的一种血栓前并发症，由抗血小板因子 4/肝素复合物的抗体引起。我们对 HIT 的认识的进展已经转化为治疗和患者预后的改善。本综述的目的是探讨该潜在致命疾病的流行病学、诊断和管理方面的最新进展和未来研究方向。
与肝素给药相关的 HIT 发展的危险因素已有很好的描述。最近确定的宿主相关危险因素增加了我们对疾病流行病学的理解。临床诊断的有限特异性和广泛使用的 HIT 免疫测定导致频繁的过度诊断。正在开发新的临床决策规则和实验室检测方法以改善诊断。磺达肝素、比伐卢定和达肝素最近已被添加到 HIT 武器库中。
尽管取得了这些进展，但仍存在一些关键问题有待解决。未来的研究工作将集中在识别新的临床危险因素和生物标志物上，这将使我们能够识别出处于最大风险的个体，优化诊断策略和使用现有的治疗方法，并开发新的药物，这些药物不仅可以降低血栓并发症的风险，而且还可以最大限度地降低出血风险，在有器官功能障碍的患者中耐受良好，并促进过渡到门诊治疗。
