Stead R B, Schafer A I, Rosenberg R D, Handin R I, Josa M, Khuri S F
Am J Med. 1984 Jul;77(1):185-8. doi: 10.1016/0002-9343(84)90459-5.
Thromboembolic complications may develop in patients with heparin-associated thrombocytopenia, presumably due to the formation of platelet aggregates. An unexpectedly high incidence of pulmonary embolism following coronary artery bypass surgery occurred during a brief period of time at a single institution, and all of these cases were found to be associated with thrombocytopenia. All patients tested during thrombocytopenia (five of five) had an increase in platelet-associated antibody. Serum samples from all five patients tested caused normal platelets to aggregate in vitro in the presence of one specific lot of beef lung heparin, which was in use in the operating room at the time; none of six other lots of beef lung heparin mediated in vitro platelet aggregation. Heparinase digestion of the heparin abolished the aggregating activity. It is concluded that thrombocytopenia and platelet activation caused by heparin may vary greatly even among different lots of heparin prepared from the same source.
血栓栓塞并发症可能在肝素相关性血小板减少症患者中发生，推测是由于血小板聚集体的形成。在某一机构的一段短暂时间内，冠状动脉搭桥手术后肺栓塞的发生率意外地高，并且所有这些病例都被发现与血小板减少症有关。血小板减少期间检测的所有患者（5例中的5例）血小板相关抗体均升高。所有5例检测患者的血清样本在手术室当时正在使用的一批特定牛肺肝素存在下，可使正常血小板在体外聚集；其他6批牛肺肝素均未介导体外血小板聚集。肝素经肝素酶消化后，其聚集活性消失。结论是，即使在同一来源制备的不同批次肝素之间，肝素引起的血小板减少和血小板活化也可能有很大差异。
