Liu Yijun, Lu Hao, Xu Hailin, Fu Zhongguo, Zhang Dianying, Jiang Baoguo
Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China.
BMC Musculoskelet Disord. 2020 Feb 7;21(1):85. doi: 10.1186/s12891-020-3117-8.
Hip fractures have become a severe public health problem, especially in very elderly patients. Most of them are treated with low molecular weight heparin as prophylaxis or treatment of venous thromboembolism. Heparin-induced thrombocytopenia is one of the complications induced by low molecular weight heparin, which may cause poor prognosis. However, there is not enough awareness for heparin-induced thrombocytopenia in very elderly trauma patients.
We report a case of hip fracture with heparin-induced thrombocytopenia in a very elderly patient. The patient developed heparin-induced thrombocytopenia, digestive hemorrhage and acute colonic pseudo-obstruction after the use of low molecular weight heparin, which eventually led to death.
This is the first case report of digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients with major trauma. This case highlights the severity of HIT in very elderly patients with hip fractures using low molecular weight heparin, and the need for platelet monitoring in these patients. We indicate that there may be a correlation of pathogenesis between digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients.
髋部骨折已成为一个严重的公共卫生问题，尤其是在高龄患者中。他们中的大多数人接受低分子量肝素治疗以预防或治疗静脉血栓栓塞。肝素诱导的血小板减少症是低分子量肝素引起的并发症之一，可能导致预后不良。然而，高龄创伤患者对肝素诱导的血小板减少症的认识不足。
我们报告一例高龄患者髋部骨折合并肝素诱导的血小板减少症。该患者在使用低分子量肝素后出现肝素诱导的血小板减少症、消化道出血和急性结肠假性梗阻，最终导致死亡。
这是首例关于肝素诱导的血小板减少症合并严重创伤患者出现消化道出血和急性结肠假性梗阻的病例报告。该病例突出了使用低分子量肝素的高龄髋部骨折患者中肝素诱导的血小板减少症的严重性，以及这些患者进行血小板监测的必要性。我们指出，肝素诱导的血小板减少症患者的消化道出血和急性结肠假性梗阻之间可能存在发病机制的相关性。
