Lamme S J, de Rooij P D, Huijgens P C, Rauwerda J A
Afd. Vaatchirurgie, Academisch Ziekenhuis Vrije Universiteit, Amsterdam.
Ned Tijdschr Geneeskd. 1994 Jan 22;138(4):189-93.
Heparin since the early sixties has played an important part in prevention and treatment of thromboembolic processes. It has hardly any side effects like allergic reactions but haemorrhage is seen more frequently. A less well-known complication is so-called heparin-induced thrombocytopenia and thrombosis (HITT). There are two different forms: a mild thrombocytopenia, characterised by a decrease in platelet count to 100-150 x 10(9)/l. This form causes no clinical symptoms. The more severe form occurs between the 7th and the 11th day after heparin administration and is characterised by paradoxically occurring thromboembolic complications. This syndrome results from formation of an antigen-antibody complex. If heparin has been administered in the past patients may develop this severe form at the moment of renewed administration. In our hospital during the past 8 years we observed 9 patients with the HITT syndrome presenting with thromboembolic complications. A thrombocyte aggregation test is diagnostically useful. Heparin-free plasma of the patient is mixed with donor thrombocytes, and heparin is added; in the HITT syndrome aggregation occurs. The main therapy is stopping the heparin administration and giving antiaggregants such as dextrans.
自20世纪60年代初以来，肝素在血栓栓塞性疾病的预防和治疗中发挥了重要作用。它几乎没有诸如过敏反应等副作用，但出血更为常见。一种不太为人所知的并发症是所谓的肝素诱导的血小板减少症和血栓形成（HITT）。有两种不同的形式：一种是轻度血小板减少症，其特征是血小板计数降至100 - 150×10⁹/L。这种形式不会引起临床症状。更严重的形式发生在肝素给药后的第7天至第11天，其特征是出现矛盾性的血栓栓塞并发症。这种综合征是由抗原 - 抗体复合物的形成引起的。如果过去曾使用过肝素，患者在再次给药时可能会出现这种严重形式。在我们医院过去8年中，我们观察到9例患有HITT综合征并出现血栓栓塞并发症的患者。血小板聚集试验在诊断上很有用。将患者的无肝素血浆与供体血小板混合，并加入肝素；在HITT综合征中会发生聚集。主要治疗方法是停止使用肝素并给予抗聚集剂，如右旋糖酐。
