Takada Shuto, Suzuki Shogo, Tamura Takahiro
Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
JA Clin Rep. 2025 Mar 28;11(1):18. doi: 10.1186/s40981-025-00781-0.
Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, including low molecular weight heparins (LMWHs) like dalteparin. While LMWHs reduces the risk of HIT compared to unfractionated heparin, vigilance remains essential.
An 82-year-old male with chronic kidney disease (CKD) developed HIT during hemodialysis anticoagulation with dalteparin, resulting in a platelet count of 17,000/µL and positive HIT antibodies. Dalteparin was replaced with nafamostat mesilate. Following confirmed HIT antibody seronegativity, elective aortic valve replacement was performed under cardiopulmonary bypass using heparin. Postoperative dialysis was managed using nafamostat mesilate, preventing HIT recurrence. His platelet count recovered after dalteparin replacement, and no recurrence of HIT was observed.
Even LMWHs, such as dalteparin, pose a HIT risk, necessitating vigilant monitoring. Confirming HIT antibody seronegativity and appropriately timing surgery are critical for patients with a history of HIT. Proper postoperative follow-up and alternative anticoagulation strategies can prevent HIT recurrence.
肝素诱导的血小板减少症（HIT）是肝素治疗的严重并发症，包括达肝素等低分子肝素（LMWHs）。虽然与普通肝素相比，低分子肝素降低了HIT的风险，但保持警惕仍然至关重要。
一名82岁患有慢性肾脏病（CKD）的男性在使用达肝素进行血液透析抗凝期间发生了HIT，导致血小板计数为17,000/µL且HIT抗体呈阳性。达肝素被甲磺酸萘莫司他替代。在确认HIT抗体血清学阴性后，在体外循环下使用肝素进行了择期主动脉瓣置换术。术后透析使用甲磺酸萘莫司他进行管理，防止了HIT复发。在达肝素替代后他的血小板计数恢复，且未观察到HIT复发。
即使是达肝素等低分子肝素也存在HIT风险，需要进行密切监测。对于有HIT病史的患者，确认HIT抗体血清学阴性并适当安排手术时间至关重要。适当的术后随访和替代抗凝策略可以预防HIT复发。
