Hantson Philippe, Lambert Catherine, Hermans Cédric
aDepartment of Intensive Care bDivision of Hematology, Université catholique de Louvain, Cliniques St-Luc, Brussels, Belgium.
Blood Coagul Fibrinolysis. 2015 Mar;26(2):205-6. doi: 10.1097/MBC.0000000000000205.
Heparin-induced thrombocytopenia (HIT) may be a critical condition in intensive care patients. Diagnosis of HIT is often difficult, and management too, as physicians have usually a limited experience with alternative anticoagulants. A 36-year-old man was admitted for orthopaedic surgery after a trauma causing a fracture of the sacrum and right ankle. Anticoagulant prophylaxis was made by nadroparin (3800 IU/day). But the patient developed less than 10 days after nadroparin exposure a significant drop in platelet count. The diagnosis of HIT was based on the pretest clinical score and demonstration of platelet factor 4 and heparin antibodies. Fondaparinux was transiently administered but was replaced 3 days later by rivaroxaban (15 mg twice a day during 21 days then 20 mg/day), after the demonstration of an acute thrombosis of the left radial artery. Platelet count returned to normal range and a partial recanalization of arterial thrombosis was noted. The use of rivaroxaban in this indication is of theoretical interest but requires further experience.
肝素诱导的血小板减少症（HIT）在重症监护患者中可能是一种危急情况。HIT的诊断通常很困难，治疗也同样困难，因为医生对替代抗凝剂的经验通常有限。一名36岁男性因创伤导致骶骨和右踝骨折后入院接受骨科手术。通过那屈肝素（3800 IU/天）进行抗凝预防。但在使用那屈肝素不到10天后，患者血小板计数显著下降。HIT的诊断基于预测试临床评分以及血小板因子4和肝素抗体的检测。短暂给予磺达肝癸钠，但3天后在证实左桡动脉急性血栓形成后，改为利伐沙班（21天内每天两次，每次15 mg，之后每天20 mg）。血小板计数恢复到正常范围，且动脉血栓部分再通。利伐沙班在此适应症中的应用具有理论意义，但需要更多经验。
