Clin Lab. 2022 Apr 1;68(4). doi: 10.7754/Clin.Lab.2021.210714.
Heparin-induced thrombocytopenia (HIT) is a severe complication caused by heparin. It is characterized by occult onset and missed diagnosis. Misdiagnosis easily occurs.
This paper reported an 85-year-old woman with an intertrochanteric fracture of the femur which was treated with low molecular weight heparin (LMWH) and fondaparinux sodium to prevent venous thrombosis. Then, the patient developed HIT. This is the first case report of HIT induced by LMWH and fondaparinux in a patient with a hip fracture. This case highlights the severity of HIT in elderly patients with hip fractures using LMWH and fondaparinux and the need for platelet monitoring in these patients.
LMWH was ceased in this HIT-confirmed patient, and non-heparin treatment was begun instead. Apixaban was given twice daily for therapeutic anticoagulation therapy. In the end, the platelet levels gradually returned to normal.
We should pay more attention to HIT and platelets during the perioperative period of orthopedic surgery, especially in elderly patients. Once the disease is confirmed, it is necessary to stop heparin-related drugs immediately and administer oral anticoagulants instead.
肝素诱导的血小板减少症（HIT）是肝素引起的严重并发症。其特点为隐匿起病和漏诊，容易误诊。
本文报道了 1 例 85 岁女性股骨转子间骨折，使用低分子肝素（LMWH）和磺达肝癸钠预防静脉血栓栓塞症，后发生 HIT。这是首例 LMWH 和磺达肝癸钠引起髋部骨折患者 HIT 的病例报告。该病例突出了老年髋部骨折患者使用 LMWH 和磺达肝癸钠时 HIT 的严重性，以及这些患者需要进行血小板监测。
对确诊为 HIT 的患者停用 LMWH，改为非肝素治疗。给予每日 2 次的阿哌沙班进行治疗性抗凝治疗。最终，血小板水平逐渐恢复正常。
我们应在骨科手术围手术期更加关注 HIT 和血小板，特别是老年患者。一旦确诊，应立即停用肝素类药物，改为口服抗凝药物。
