Fornaro G, Sansa M, Dellavesa P, Cernigliaro C
Divisione di Cardiologia, Ospedale Maggiore, Novara.
G Ital Cardiol. 1993 Apr;23(4):357-63.
We report a case of a 61-year-old woman admitted to our Coronary Care Unit for pulmonary embolism following cholecystectomy. After thrombolytic therapy, and during treatment with heparin (administered as a continuous intravenous infusion in the standard dose), the patient had a recurrence of pulmonary embolism and a subsequent implant of a Gianturco-Rohem vena cava filter. The patient presented an initial reduction in the number of platelets from 477 x 10(3)/microliters to 360 x 10(3)/microliters that was ascribed to a heparin side effect or to a blocking of the platelets in a massive pulmonary thrombosis. A predischarge platelet count, however, showed an elevated number of thrombocytes (944 x 10(3)/microliters) and hyperfibrinogenemia (fibrinogen = 750 mg/dl). Essential thrombocythemia was demonstrated and treated with interferon alpha-2b-recombinant 3,000,000 U.I. on alternate days with a reduction in platelets to 450 x 10(3)/microliters. This case demonstrates the necessity of exploring, during pulmonary embolism, all possible causes of hypercoagulability in the course of thrombolytic therapy.
我们报告一例61岁女性患者，因胆囊切除术后发生肺栓塞入住我院冠心病监护病房。在溶栓治疗后，以及使用肝素（以标准剂量持续静脉输注）治疗期间，患者发生了肺栓塞复发，随后植入了Gianturco-Rohem腔静脉滤器。患者最初血小板计数从477×10³/微升降至360×10³/微升，这归因于肝素副作用或大量肺血栓形成中血小板的聚集。然而，出院前血小板计数显示血小板数量升高（944×10³/微升）和高纤维蛋白原血症（纤维蛋白原 = 750毫克/分升）。确诊为原发性血小板增多症，并使用重组干扰素α-2b 3,000,000 U.I.隔日治疗，血小板数量降至450×10³/微升。该病例表明，在肺栓塞溶栓治疗过程中，有必要探寻所有可能导致高凝状态的原因。
