Kitzis M, Huisse M G, Hannoun L, Couffinhal J C, Parmentier G, Andreassian B
J Mal Vasc. 1980;5(4):277-80.
The most frequent complication during heparin treatment is hemorrhage from overdosage. Heparin-induced thrombopenia is more rarely observed but is a more serious disorder. Six such cases are reported, of which three were complicated by gangrene of the limbs. Clinical findings are described, together with the methods of detecting the presence of heparin-induced antiplatelet antibodies. The affection becomes evident on the 9th day of treatment by the presence of a thrombopenia and accompanying clinical signs. These may be those of a hemorrhagic syndrome directly related to the thrombopenia, or manifestations of thrombotic lesions. The latter can cause worsening of the condition for which heparin was prescribed, arterial thrombosis of a large vessel, venous thromboses disappearing after interruption of heparin treatment, of distal thrombosis of the microcirculation with a rapidly irreversible onset of gangrene requiring amputation. The lesions are provoked by an immune mechanism and heparin has to be discontinued.
肝素治疗期间最常见的并发症是过量引起的出血。肝素诱导的血小板减少症较少见，但却是一种更严重的病症。本文报告了6例此类病例，其中3例并发肢体坏疽。文中描述了临床发现以及检测肝素诱导的抗血小板抗体存在的方法。在治疗第9天时，血小板减少症及伴随的临床体征会使病情变得明显。这些体征可能是与血小板减少症直接相关的出血综合征的体征，也可能是血栓形成病变的表现。后者可导致使用肝素治疗的病情恶化、大血管的动脉血栓形成、肝素治疗中断后消失的静脉血栓形成，或微循环的远端血栓形成，并迅速发展为不可逆的坏疽，需要截肢。这些病变是由免疫机制引发的，必须停用肝素。
