Yumoto Tetsuya, Sato Keiji, Fujii Nobuharu, Kinami Yo, Tsukahara Kohei, Ugawa Toyomu, Ichiba Shingo, Ujike Yoshihito
Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan.
Department of Hematology and Oncology Okayama University Hospital Okayama Japan.
Acute Med Surg. 2015 May 28;3(1):46-49. doi: 10.1002/ams2.132. eCollection 2016 Jan.
We present three cases in which patients that had suffered polytrauma developed heparin-induced thrombocytopenia after the start of heparin treatment for thrombosis. All three patients had high injury severity scores and required major surgery. They all started receiving unfractionated heparin for deep venous thrombosis with or without an asymptomatic pulmonary embolism. The patients were clinically diagnosed with heparin-induced thrombocytopenia after their platelet counts fell or exhibited a delayed recovery.
Heparin-induced thrombocytopenia and the associated thromboses were successfully treated by discontinuing all forms of heparin treatment and administering argatroban followed by warfarin.
Early recognition and clinical diagnosis of heparin-induced thrombocytopenia is necessary for clinicians in cases in which severely injured trauma patients show reductions or delayed recovery in their platelet counts in combination with thrombosis after starting heparin treatment.
我们呈现三例多发伤患者，他们在开始使用肝素治疗血栓形成后发生了肝素诱导的血小板减少症。所有三名患者损伤严重程度评分都很高，且需要进行大手术。他们均开始接受普通肝素治疗深静脉血栓形成，伴或不伴有无症状肺栓塞。在血小板计数下降或恢复延迟后，这些患者被临床诊断为肝素诱导的血小板减少症。
通过停用所有形式的肝素治疗并给予阿加曲班随后使用华法林，肝素诱导的血小板减少症及相关血栓形成得到了成功治疗。
对于严重受伤的创伤患者，在开始肝素治疗后出现血小板计数减少或恢复延迟并伴有血栓形成的情况下，临床医生有必要早期识别并临床诊断肝素诱导的血小板减少症。
