Makhoul R G, Greenberg C S, McCann R L
J Vasc Surg. 1986 Nov;4(5):522-8. doi: 10.1067/mva.1986.avs0040522.
Heparin-associated thrombocytopenia and thrombosis (HATT) is an unusual but serious complication of heparin therapy. Twenty-five patients (13 men and 12 women) had thrombocytopenia and arterial or venous thrombosis 1 to 10 days (mean, 6.3 days) after the start of heparin administration. The vessels in the affected extremity had been entered for catheterization, arteriography, or passage of a balloon counterpulsation device in 19 of the 25 patients. In vitro platelet aggregation with heparin was seen in all patients. Additional studies were performed to see whether other lots or sources of heparin also produced in vitro aggregation. Four separate lots of beef lung heparin, commercial heparin from porcine intestinal mucosa, and two types of low molecular weight heparin were all highly stimulatory in this system. However, Org 10172, a heparinoid, did not induce aggregation in any of 13 patient plasmas tested. Inhibition of platelet aggregation by aspirin was also examined. Aspirin abolished in vitro aggregation in 9 of 16 cases and decreased the degree of aggregation from 85% to 55% (p = 0.02) in the remaining seven cases. We conclude that in patients with HATT platelet aggregation is equally induced by beef lung, porcine intestinal, and some forms of low molecular weight heparin. Org 10172 does not stimulate platelet aggregation in plasma from these patients in vitro. Finally, there may be a role for aspirin in treating patients with HATT.
肝素相关性血小板减少症和血栓形成（HATT）是肝素治疗中一种不常见但严重的并发症。25例患者（13例男性和12例女性）在开始使用肝素后1至10天（平均6.3天）出现血小板减少症以及动脉或静脉血栓形成。25例患者中有19例在受累肢体的血管进行过导管插入术、动脉造影或使用过球囊反搏装置。所有患者均出现肝素诱导的体外血小板聚集。进行了额外的研究以观察其他批次或来源的肝素是否也能产生体外聚集。四批不同的牛肺肝素、猪肠黏膜商业肝素以及两种低分子肝素在该系统中均具有高度刺激性。然而，类肝素Org 10172在测试的13例患者血浆中均未诱导聚集。还研究了阿司匹林对血小板聚集的抑制作用。阿司匹林使16例中的9例体外聚集消失，并使其余7例的聚集程度从85%降至55%（p = 0.02）。我们得出结论，在HATT患者中，牛肺肝素、猪肠肝素和某些形式的低分子肝素均可同等程度地诱导血小板聚集。Org 10172在体外不会刺激这些患者血浆中的血小板聚集。最后，阿司匹林在治疗HATT患者中可能有一定作用。
