Lefemine A A
Am Surg. 1982 May;48(5):202-6.
Four cases are presented which are believed to represent thrombocytopenia associated with intravascular thrombosis and vascular occlusion in patients receiving heparin. Patients with gangrene all had pre-existing arterial disease and arterial insufficiency. Such venous and arterial thromboses are paradoxic and unpredictable and are completely against the goal of therapy. These complications may have been prevented if the developing thrombocytopenia was discovered earlier and heparin discontinued. Three of these patients died as a result of their complications, and one had an amputation. The unpredictable pattern of such paradoxic reactions requires close monitoring of the platelet count as well as activated PTT and prothrombin time.
本文报告了4例病例，据信这些病例代表了接受肝素治疗的患者中与血管内血栓形成和血管闭塞相关的血小板减少症。发生坏疽的患者均有既往动脉疾病和动脉供血不足。这种静脉和动脉血栓形成是反常且不可预测的，完全违背了治疗目标。如果能更早发现血小板减少症的发展并停用肝素，这些并发症可能是可以预防的。其中3例患者因并发症死亡，1例患者接受了截肢手术。这种反常反应的不可预测模式需要密切监测血小板计数以及活化部分凝血活酶时间（activated PTT）和凝血酶原时间。
