RCX 支架内发生接近致命性血栓形成，为肝素诱导的血小板减少症（HIT）的首发表现，且血小板计数正常。
Near fatal stent thrombosis in an aneurysmatic RCX as first manifestation of heparin induced thrombocytopenia (HIT) without thrombocytopenia.
机构信息
Intensive Care Unit, DRK Kliniken Berlin Köpenick, Berlin, Germany.
Medizinische Klinik Kardiologie, DRK Kliniken Berlin Köpenick, S.-Allende-Str. 2-8, Berlin, 12559, Germany.
出版信息
BMC Cardiovasc Disord. 2021 Dec 31;21(1):624. doi: 10.1186/s12872-021-02442-3.
BACKGROUND
Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention.
CASE PRESENTATION
A supposedly "completely healthy" 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis.
CONCLUSIONS
The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.
背景
肝素诱导的血小板减少症（HIT）导致的血栓形成在约 2%的患者中发生，而血小板计数无明显下降。我们报告了一起由冠状动脉介入引起的近乎致命的血栓形成事件。
病例介绍
一位看似“完全健康”的 53 岁患者因降主动脉夹层动脉瘤破裂而住院。他成功接受了手术治疗，六天后因 NSTEMI 接受了冠状动脉造影。在干预 90%的 RCX 狭窄后，他立即出现心室颤动，进行了除颤，再次血管造影显示 RCX 支架部分闭塞。抽吸导管可取出大量白色血栓，提示存在无血小板减少的 HIT。免疫测定法检测到血小板因子 4/肝素复合物抗体，并随后进行肝素诱导的血小板激活试验证实了这一诊断。
结论
即使血小板计数正常，急性支架血栓形成的临床事件也应引起介入团队对 HIT 的诊断的警惕。
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