Department of Neurosurgery, College of Medicine, University of Illinois at Chicago, 60612-7329, USA.
J Neurointerv Surg. 2010 Dec;2(4):371-8. doi: 10.1136/jnis.2010.002840. Epub 2010 Jul 23.
The incidence of heparin induced thrombocytopenia (HIT) in neurological patients continues to increase with expansion of indication for neurointerventional procedures. The pathophysiology of HIT is related to a hypersensitivity reaction against complex platelet factor 4. The diagnosis is mostly clinical and is often confirmed by laboratory testing. Patients with HIT have a higher rate of thromboembolic complications, both arterial and venous, and with worse neurological outcomes at the time of discharge. Early diagnosis and heparin cessation are essential in the management of those patients. Both immediate and prolonged alternative anticoagulation are necessary. Understanding of the mechanism of action, indication and drug interaction of the alternative anticoagulants (direct thrombin inhibitors, fondaparinux and danaparoid) and warfarin is essential during management of these patients.
神经介入治疗适应证的扩展导致神经科患者肝素诱导的血小板减少症（HIT）的发病率持续增加。HIT 的病理生理学与针对复杂血小板因子 4 的超敏反应有关。诊断主要基于临床，通常通过实验室检查来确认。HIT 患者发生动静脉血栓栓塞并发症的风险更高，且出院时的神经学结局更差。此类患者的管理中，早期诊断和停用肝素至关重要。即刻和长期替代抗凝治疗均是必要的。在管理这些患者时，必须了解替代抗凝药物（直接凝血酶抑制剂、磺达肝癸钠和达那肝素）和华法林的作用机制、适应证和药物相互作用。
