Almeida J I, Coats R, Liem T K, Silver D
Department of Surgery, University of Missouri-Columbia, 65212, USA.
J Vasc Surg. 1998 Feb;27(2):309-14; discussion 315-6. doi: 10.1016/s0741-5214(98)70361-1.
We reported a 61% morbidity rate and a 23% mortality rate for the heparin-induced thrombocytopenia (HIT) syndrome in 1983. We subsequently reported in 1987 that with early recognition, immediate cessation of the administration of heparin, and platelet function inhibition, the morbidity rate could be reduced to 23% and the mortality rate to 12%. One hundred recent cases of patients with heparin-associated antiplatelet antibodies (HAAb) have been reviewed to determine whether aggressive screening, early diagnosis, and alternate management could further reduce morbidity and mortality rates.
The consecutive records of 100 patients with positive platelet aggregation tests were reviewed. Sixty-six patients were male. The patients' ages ranged from 23 days to 92 years. The patients were from vascular (28), cardiothoracic (42), and other (30) services. HIT was suspected in patients who received heparin and had falling platelet counts, platelet counts less than 100,000/mm3, or new thromboembolic or hemorrhagic events.
Heparin was not offered to six patients with known HAAb. Twelve patients were successfully treated with antiplatelet therapy and limited reexposure to heparin, and 75 patients were successfully treated with early diagnosis and prompt cessation of heparin. Alternate forms of anticoagulation therapy were used selectively. Seven patients had 11 complications. Three of the seven patients were treated successfully with warfarin anticoagulation and aspirin (2) or with aspirin alone (1). A fourth patient was treated with thrombectomy, hematoma evacuation, and aspirin. A fifth patient underwent thrombolysis and coronary angioplasty in addition to receiving warfarin and aspirin. The sixth patient required two thrombectomies and warfarin. A seventh patient required two thrombectomies and aspirin. HIT was responsible for one of 17 deaths.
A 7.4% morbidity rate and a 1.1% mortality rate have been achieved in patients with HAAb by aggressive screening, early recognition of HIT, and prompt cessation of the administration of heparin. Platelet function inhibitors and other anticoagulants, including nonreacting low molecular weight heparin, are important adjuncts in the management of the thromboembolic disorders associated with HIT.
1983年我们报告肝素诱导的血小板减少症（HIT）综合征的发病率为61%，死亡率为23%。随后在1987年我们报告，通过早期识别、立即停止肝素给药以及抑制血小板功能，发病率可降至23%，死亡率降至12%。回顾了近期100例肝素相关抗血小板抗体（HAAb）患者的病例，以确定积极筛查、早期诊断及替代治疗是否能进一步降低发病率和死亡率。
回顾了100例血小板聚集试验呈阳性患者的连续记录。66例为男性。患者年龄从23天至92岁不等。患者来自血管外科（28例）、心胸外科（42例）及其他科室（30例）。接受肝素治疗且血小板计数下降、血小板计数低于100,000/mm³或出现新的血栓栓塞或出血事件的患者被怀疑患有HIT。
6例已知HAAb的患者未使用肝素。12例患者通过抗血小板治疗及有限度地再次使用肝素成功治愈，75例患者通过早期诊断及迅速停用肝素成功治愈。选择性地使用了其他形式的抗凝治疗。7例患者出现11例并发症。7例患者中的3例通过华法林抗凝及阿司匹林（2例）或仅使用阿司匹林（1例）成功治疗。第4例患者接受了血栓切除术、血肿清除术及阿司匹林治疗。第5例患者除接受华法林和阿司匹林治疗外，还接受了溶栓及冠状动脉血管成形术。第6例患者需要两次血栓切除术及华法林治疗。第7例患者需要两次血栓切除术及阿司匹林治疗。HIT是17例死亡病例中的1例病因。
通过积极筛查、早期识别HIT及迅速停止肝素给药，HAAb患者的发病率为7.4%，死亡率为1.1%。血小板功能抑制剂及其他抗凝剂，包括无交叉反应的低分子量肝素，是与HIT相关的血栓栓塞性疾病治疗中的重要辅助药物。
