Laprevote-Heully M C, Bollaert P E, Bauer P, Briquel M E, Alexandre P, Lambert H, Larcan A
Service d'Urgence et Réanimation Médicale, Hôpital Central, Nancy.
J Mal Vasc. 1987;12 Suppl B:133-7.
Heparin induced thrombocytopenia is characterized by often dramatic evolution of thrombotic arterial and venous complications. These occurred or are worsened in curative or preventive heparin therapy and the treatment remains delicate. The authors report 32 observations of thrombocytopenia complicated with thromboembolic events; seven deaths are to mention. The tests of platelet aggregation with standard heparin and platelets poor patient's plasma confirm the diagnosis in 28 cases of 30 very early studied and in 2 cases around the 6th day only after the stop of standard heparin. The choice of anticoagulant therapy is carried out the negative tests of platelet aggregation with low molecular weight heparin (L.M.W.H.) (CY 216, CY 222 Choay, PK 10109 Pharmuka). In L.M.W. heparin therapy, clinical and biological improvement is obtained in 26 cases of 30 treated cases. In three cases, the rapid climbing of platelet countings is not present although negative tests of platelet aggregation with selected L.M.W.H. In one case, after a initial climbing of platelet countings, the thrombocytopenia recurs rapidly with L.M.W. heparin after a operation. The immediate or secondary passage with K-antivitamins, platelet antiaggregant stabilized medium and long term's evolution.
肝素诱导的血小板减少症的特征通常是血栓形成的动脉和静脉并发症急剧发展。这些并发症在肝素的治疗性或预防性治疗中出现或恶化，治疗仍然棘手。作者报告了32例血小板减少症并发血栓栓塞事件的病例；其中7例死亡。用标准肝素和血小板减少患者的血浆进行血小板聚集试验，在30例极早期研究的病例中有28例在停用标准肝素后仅在第6天左右的2例中确诊。抗凝治疗的选择是通过用低分子量肝素（CY 216、CY 222 Choay、PK 10109 Pharmuka）进行血小板聚集阴性试验来进行的。在低分子量肝素治疗中，30例治疗病例中有26例临床和生物学状况得到改善。在3例中，尽管用选定的低分子量肝素进行血小板聚集试验为阴性，但血小板计数并未迅速上升。在1例中，血小板计数最初上升后，术后使用低分子量肝素时血小板减少症迅速复发。立即或继发改用K族维生素、血小板抗聚集稳定介质及长期演变情况。
