Department of Clinical Biochemistry, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University. Address: Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, Australia.
Expert Rev Hematol. 2021 Apr;14(4):335-346. doi: 10.1080/17474086.2021.1905512. Epub 2021 Mar 30.
: Immune-mediated heparin-induced thrombocytopenia (HIT) is an infrequent complication following heparin exposure but with potentially fatal outcome due to thrombotic complications. Prompt suspension of heparin is necessary if HIT is suspected, followed by initiation of non-heparin anticoagulant therapy.: In this review, the pathophysiology and challenges in diagnosing HIT are elucidated. Current and emerging treatment options are discussed with special focus on parenteral thrombin inhibitors (argatroban, bivalirudin), parenteral factor Xa inhibitors (danaparoid, fondaparinux) and direct oral anticoagulants (DOACs [rivaroxaban, apixaban, dabigatran]) including dosing strategies for DOACs. The database PubMed was employed without time boundaries.: Only argatroban holds regulatory approval for HIT treatment in both U.S. and Europe. This treatment is, however, challenged by the need for close monitoring and high costs. Fondaparinux has been increasingly used for off-label treatment and during recent years, evidence for the use of DOACs has emerged. Preliminary results from observational studies hold promise for future use of DOACs in the acute and subacute phase of HIT. However, so far, the use of DOACs in acute HIT should be reserved for clinically stable patients without severe thrombotic complications. Importantly, both fondaparinux and DOAC use is contraindicated in severe renal insufficiency.
免疫介导的肝素诱导的血小板减少症（HIT）是肝素暴露后罕见的并发症，但由于血栓并发症，可能导致致命后果。如果怀疑发生 HIT，必须立即停止肝素，并启动非肝素抗凝治疗。
在这篇综述中，阐明了 HIT 的病理生理学和诊断挑战。讨论了当前和新兴的治疗选择，特别关注了静脉注射用凝血酶抑制剂（阿加曲班、比伐卢定）、静脉注射用 Xa 因子抑制剂（达肝素钠、磺达肝癸钠）和直接口服抗凝剂（DOACs [利伐沙班、阿哌沙班、达比加群]），包括 DOACs 的剂量策略。使用 PubMed 数据库进行检索，未设置时间限制。
只有阿加曲班在美国和欧洲获得了 HIT 治疗的监管批准。然而，这种治疗方法受到需要密切监测和高成本的挑战。磺达肝癸钠已越来越多地被用于超适应证治疗，近年来，DOACs 的使用证据也不断涌现。来自观察性研究的初步结果为 DOACs 在 HIT 的急性和亚急性期的未来应用带来了希望。然而，迄今为止，在急性 HIT 中使用 DOACs 应仅限于无严重血栓并发症的临床稳定患者。重要的是，磺达肝癸钠和 DOACs 的使用均禁忌用于严重肾功能不全的患者。
