Allal J, Petitalot J P, Poupet J Y, Chaix A F, Barraine R, Rousseau G
Ann Cardiol Angeiol (Paris). 1984 Jul-Sep;33(5):269-72.
The authors report three cases of heparin-induced thrombocytopenia. Two cases were associated with deep venous thrombosis and pulmonary embolism and the other case was associated with arterial embolism. The clinical course was serious, with one death and one amputation of a limb. The thrombocytopenia developed suddenly, 10 to 15 days after the start of treatment; the platelet count was always below 100 000/mm3. The platelet aggregation test is an important diagnostic element, together with the rapid return to normal of the platelet count once the heparin is stopped. An anti-platelet antibody was detected in two patients, suggesting an immuno-allergic mechanism for this new complication of heparin treatment. The treatment consist of immediately stopping the heparin and replacing it with an anti-vitamin K drug or low-molecular weight heparin. The platelet count should be monitored systematically in all patients receiving heparin treatment for more than 8 days.
作者报告了3例肝素诱导的血小板减少症。2例与深静脉血栓形成和肺栓塞相关，另一例与动脉栓塞相关。临床过程严重，1例死亡，1例截肢。血小板减少症在治疗开始后10至15天突然出现；血小板计数始终低于100 000/mm³。血小板聚集试验是一项重要的诊断依据，同时肝素停用后血小板计数迅速恢复正常。在2例患者中检测到抗血小板抗体，提示肝素治疗这一新并发症存在免疫过敏机制。治疗包括立即停用肝素，并用抗维生素K药物或低分子量肝素替代。对于所有接受肝素治疗超过8天的患者，应系统监测血小板计数。
