达比加群酯在肝素诱导的血小板减少症伴血栓形成后使用：病例系列及文献复习。

Dabigatran Use after Argatroban for Heparin-induced Thrombocytopenia with Thrombosis: A Case Series and Literature Review.

机构信息

Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China.; Department of Cardiac Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China.

Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China.

出版信息

Ann Vasc Surg. 2022 Mar;80:392.e1-392.e7. doi: 10.1016/j.avsg.2021.08.022. Epub 2021 Oct 14.

DOI:10.1016/j.avsg.2021.08.022

PMID:34656708

Abstract

BACKGROUND

Heparin-induced thrombocytopenia (HIT) is immune-mediated thrombotic thrombocytopenia following the use of heparin, which contributes to a high limb-amputation rate and mortality if not appropriately handled. There is growing evidence suggesting that novel oral anticoagulants (NOACs) may be effective for treating HIT.

METHODS

We described five rare cases of patients with HIT associated with deep vein thrombosis treated with dabigatran, a member of NOACs. We also reviewed representative cases and literature investigating the use of NOACs to treat patients with HIT to further discuss the efficacy and safety.

RESULTS AND CONCLUSIONS

Following the treatment of dabigatran after argatroban, the platelet count of patients with HIT gradually elevated and reached the normal range eventually. There was no incidence of new symptomatic, objectively-confirmed arteriovenous thromboembolism observed within the 90-day-period follow up. The patient in case 3 presented with gastric bleeding after dabigatran treatment and died in the end. The results suggested that dabigatran use after argatroban may be effective in the treatment of patients with HIT. However, safety should be reconsidered since severe complications were observed in case 3.

摘要

背景

肝素诱导的血小板减少症（HIT）是在使用肝素后发生的免疫介导性血栓性血小板减少症，如果处理不当，会导致高截肢率和死亡率。越来越多的证据表明，新型口服抗凝剂（NOACs）可能对治疗 HIT 有效。

方法

我们描述了五例罕见的 HIT 合并深静脉血栓患者使用达比加群治疗的病例。我们还回顾了代表性病例和研究使用 NOACs 治疗 HIT 患者的文献，以进一步讨论其疗效和安全性。

结果和结论

在使用阿加曲班后，HIT 患者的血小板计数逐渐升高，最终达到正常范围。在 90 天的随访期内，未观察到新的有症状、客观证实的动静脉血栓栓塞事件发生。第 3 例患者在使用达比加群后出现胃出血，最终死亡。结果表明，在使用阿加曲班后使用达比加群可能对治疗 HIT 患者有效。然而，鉴于第 3 例患者出现严重并发症，应重新考虑其安全性。