Department of Neurology, Osaka University Graduate School of Medicine, Japan.
Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Japan.
Intern Med. 2022 Sep 15;61(18):2797-2801. doi: 10.2169/internalmedicine.9531-22. Epub 2022 Jul 5.
A 53-year-old woman with severe coronavirus disease 2019 (COVID-19) pneumonia was admitted and treated with intravenous unfractionated heparin for thromboprophylaxis under general anesthesia with mechanical ventilation. She developed right hemiparesis after hospitalization due to a large hemorrhagic infarction. Her platelet count decreased from 243,000/μL at administration to 121,000/μL. Anti-platelet factor 4-heparin antibody testing was positive according to a latex immunoturbidimetric assay. She was therefore diagnosed with heparin-induced thrombocytopenia. We immediately stopped the heparin and started argatroban; the platelet count recovered, and thrombosis did not relapse. Physicians should consider heparin-induced thrombocytopenia as a cause of ischemic stroke in patients with COVID-19 infection.
一位 53 岁的女性患有严重的 2019 年冠状病毒病（COVID-19）肺炎，在全身麻醉机械通气下接受静脉普通肝素进行血栓预防。她因大的出血性梗死而在住院后出现右侧偏瘫。她的血小板计数从给药时的 243,000/μL 下降至 121,000/μL。根据乳胶免疫比浊测定，抗血小板因子 4-肝素抗体检测呈阳性。因此，她被诊断为肝素诱导的血小板减少症。我们立即停止使用肝素并开始使用阿加曲班；血小板计数恢复，血栓未再复发。医生应考虑 COVID-19 感染患者的缺血性中风是肝素诱导的血小板减少症所致。
