早期大剂量静脉注射免疫球蛋白治疗难治性肝素诱导的血小板减少症伴卒中：两例报告
Early high-dose intravenous immunoglobulin for refractory heparin-induced thrombocytopenia with stroke: Two case reports.
作者信息
Makita Naoki, Ohara Tomoyuki, Tsuji Yukiko, Ueda Tetsuhiro, Nakamura Takuma, Mizuno Toshiki, Makino Masahiro
机构信息
Department of Neurology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.
Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107032. doi: 10.1016/j.jstrokecerebrovasdis.2023.107032. Epub 2023 Jan 24.
BACKGROUND
High-dose intravenous immunoglobulin (IVIg) can be effective for patients with refractory autoimmune heparin-induced thrombocytopenia (HIT). We report two patients with autoimmune HIT (aHIT) successfully treated with early high-dose IVIg.
CASE DESCRIPTION
Case 1 was a 48-year-old male who had persisting HIT with recurrent ischemic stroke after mitral valve replacement. Case 2 was a 71-year-old male who had flush heparin HIT with cerebral venous thrombosis after total hip arthroplasty. High-dose IVIg was administered 6 and 4 days after starting argatroban due to non-improved thrombocytopenia and persistently high D-dimer values, respectively. Both patients achieved favorable functional recovery at discharge as well as improvements of thrombocytopenia and hypercoagulation.
CONCLUSIONS
Early high-dose IVIg may be effective for patients with aHIT and hypercoagulability.
背景
高剂量静脉注射免疫球蛋白（IVIg）对难治性自身免疫性肝素诱导的血小板减少症（HIT）患者可能有效。我们报告了两名自身免疫性HIT（aHIT）患者通过早期高剂量IVIg成功治疗的病例。
病例描述
病例1是一名48岁男性，在二尖瓣置换术后出现持续性HIT并伴有复发性缺血性中风。病例2是一名71岁男性，在全髋关节置换术后出现肝素冲洗相关的HIT并伴有脑静脉血栓形成。由于血小板减少症未改善以及D - 二聚体值持续升高，分别在开始使用阿加曲班6天和4天后给予高剂量IVIg。两名患者出院时均实现了良好的功能恢复，血小板减少症和高凝状态也有所改善。
结论
早期高剂量IVIg可能对aHIT和高凝状态患者有效。
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