Lathan L O, Staggers S L
University of Virginia Health Sciences Center, Charlottesville, USA.
Heart Lung. 1996 Nov-Dec;25(6):451-60; quiz 461-2. doi: 10.1016/s0147-9563(96)80046-x.
Heparin-induced thrombocytopenia and thrombosis, also known as heparin-associated thrombocytopenia and thrombosis, was diagnosed in a 73-year-old man who had sustained a pelvic fracture, which was complicated by a left, deep-vein thrombosis. Heparin was administered and thrombocytopenia and arterial thrombosis of his left foot developed, which required amputation of three lateral toes. Four years later, the patient experienced a heart attack, and subsequently postinfarction angina developed, which was refractory to treatment with aspirin, nitrates, and beta-blockers. He was referred to a large, 750-bed teaching hospital for cardiac catheterization and possible coronary artery bypass grafting. An alternative treatment was needed for rapid anticoagulation. Ancrod, snake venom from the Malayan pit viper, was used to lower plasma fibrinogen levels, which allowed successful cardiac catheterization and coronary artery bypass grafting. We present a case study of the successful treatment of this patient with use of ancrod, and the nursing management for patients with heparin-induced or heparin-associated thrombocytopenia and thrombosis receiving this drug.
肝素诱导的血小板减少症和血栓形成，也称为肝素相关性血小板减少症和血栓形成，在一名73岁男性中被诊断出来，该患者骨盆骨折，并发左下肢深静脉血栓形成。给予肝素后，患者出现血小板减少症和左足动脉血栓形成，导致三个外侧脚趾被截肢。四年后，患者发生心脏病发作，随后出现心肌梗死后心绞痛，阿司匹林、硝酸盐和β受体阻滞剂治疗无效。他被转诊到一家拥有750张床位的大型教学医院进行心脏导管插入术和可能的冠状动脉搭桥手术。需要一种替代治疗方法来进行快速抗凝。安克洛酶，一种来自马来亚蝰蛇的蛇毒，被用于降低血浆纤维蛋白原水平，从而使心脏导管插入术和冠状动脉搭桥手术得以成功进行。我们展示了一个使用安克洛酶成功治疗该患者的病例研究，以及接受这种药物治疗的肝素诱导或肝素相关性血小板减少症和血栓形成患者的护理管理。
