Miyagawa Atsushi, Yuri Koichi, Nakano Mitsunori, Shinoda Daigo, Makino Jun
Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Department of Critical Care Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Ann Vasc Dis. 2022 Dec 25;15(4):352-355. doi: 10.3400/avd.cr.22-00082.
We report a case of a 77-year-old woman with massive pulmonary embolism associated with heparin-induced thrombocytopenia. Before developing a pulmonary embolism, the patient underwent gastrectomy due to gastric cancer and received subcutaneous heparin calcium for deep venous thrombosis prophylaxis for 5 d. Then, thrombectomy with cardiopulmonary bypass using full heparinization was successfully performed. The patient was definitively diagnosed with this condition postoperatively, based on elevated serum antibody levels, in addition to pre- and postoperative thrombocytopenia and thrombosis. Intravenous heparin therapy was switched to argatroban. Although it is uncommon, clinicians should consider this condition in patients with a history of heparin exposure.
我们报告一例77岁女性，患有与肝素诱导的血小板减少症相关的大面积肺栓塞。在发生肺栓塞之前，该患者因胃癌接受了胃切除术，并接受皮下注射肝素钙预防深静脉血栓形成5天。然后，在全身肝素化的情况下成功进行了体外循环下的血栓切除术。除术前和术后血小板减少及血栓形成外，术后根据血清抗体水平升高，该患者被明确诊断为此病。静脉肝素治疗改为阿加曲班。尽管这种情况并不常见，但临床医生应对有肝素暴露史的患者考虑这种疾病。
