Williams Jonathan S, Autori Paula J, Kidd Stephen K, Piazza Gregory, Connors Molly C, Czeisler Charles A, Scheuermaier Karine D, Duffy Jeanne, Klerman Elizabeth B, Scheer Frank A, Kozak Marjorie, Driscoll Sheila M, Goldhaber Samuel Z
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Center for Clinical Investigations, Brigham and Women's Hospital, Boston, Massachusetts, United States.
TH Open. 2018 Jan 30;2(1):e49-e53. doi: 10.1055/s-0038-1624565. eCollection 2018 Jan.
The risk for developing heparin-induced thrombocytopenia in healthy individuals is thought to be low, but monitoring recommendations remain controversial. Therefore, a retrospective cohort study was conducted to identify the incidence of thrombocytopenic events in a healthy research population exposed and re-exposed to continuous intravenous (IV) unfractionated heparin. The Division of Sleep Medicine and the Centre for Clinical Investigations at Brigham and Women's Hospital, Boston, Massachusetts, United States, instituted a standardized platelet monitoring procedure for all research protocols that involved heparin to detect platelet count decreases. Protocol-related frequent blood sampling required use of continuous IV unfractionated heparin infusion (5,000 unit/L in 0.45% saline at 40 mL/h) to maintain line patency over extended periods of IV access. From the years 2009 to 2012, a total of 273 healthy volunteers enrolled in Sleep Medicine research protocols met study criteria as having been exposed and/or re-exposed to continuously infused intravenous heparin for at least 4 hours. The mean continuous heparin exposure time was 88 ± 82 SD hours with a total of 397 heparin exposure and re-exposure events. Platelet count measurements were obtained on 629 occasions, representing a range from 2 to 9 draws per participant. No platelet count decrease of more than 50% was detected. There were no detected adverse bleeding or thrombotic events. In this retrospective study of healthy volunteers involved in a rigorously applied inpatient platelet monitoring protocol, heparin exposure and re-exposure did not lower platelet concentration and, therefore, does not appear to be associated with increased risk of HIT in this population.
健康个体发生肝素诱导的血小板减少症的风险被认为较低，但监测建议仍存在争议。因此，开展了一项回顾性队列研究，以确定在健康研究人群中暴露于连续静脉注射（IV）普通肝素并再次暴露后的血小板减少事件发生率。美国马萨诸塞州波士顿市布莱根妇女医院睡眠医学科和临床研究中心，针对所有涉及肝素的研究方案制定了标准化的血小板监测程序，以检测血小板计数下降情况。与方案相关的频繁血液采样需要使用连续静脉注射普通肝素输注（在0.45%盐水中以40 mL/h的速度输注5000单位/L），以在长时间静脉通路期间维持血管通畅。在2009年至2012年期间，共有273名参与睡眠医学研究方案的健康志愿者符合研究标准，即已暴露于和/或再次暴露于连续静脉输注肝素至少4小时。平均连续肝素暴露时间为88±82标准差小时，共有397次肝素暴露和再次暴露事件。共进行了629次血小板计数测量，每位参与者的测量次数范围为2至9次。未检测到血小板计数下降超过50%的情况。未检测到不良出血或血栓形成事件。在这项对参与严格应用的住院血小板监测方案的健康志愿者的回顾性研究中，肝素暴露和再次暴露并未降低血小板浓度，因此，在该人群中似乎与肝素诱导的血小板减少症风险增加无关。
