Samama C M
Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Presse Med. 1998 Jun;27 Suppl 2:18-21.
A COMPLEX SITUATION: During the acute phase of heparin-induced thrombocytopenia, the question must be raised as to whether an antithrombotic therapy is to be continued using a compound other than heparin. Later the risk of reintroducing heparin again can be discussed. THERAPEUTIC PROPOSITIONS: Excepting vena cava interruption, surgical revascularization and thrombolysis, possible therapeutic propositions can be divided into two categories; anticoagulants and related compounds (hirudin); and oral anticoagulants (anti-vitamin K) and antiplatelet agents (aspirin for example). Low molecular-weight heparin cannot be recommended in 1998 in patients with heparin-induced thrombocytopenia due to standard heparin.
Unfractionated heparin or low-molecular weight heparin must be stopped immediately. The hematology laboratory should be consulted. It must be remembered that prevention, based on a careful assessment of the benefit/risk ratio when initiating heparin therapy, is essential.
复杂情况：在肝素诱导的血小板减少症急性期，必须提出是否使用肝素以外的化合物继续进行抗血栓治疗的问题。之后可以讨论再次引入肝素的风险。治疗建议：除了腔静脉阻断、手术血管重建和溶栓外，可能的治疗建议可分为两类；抗凝剂及相关化合物（水蛭素）；以及口服抗凝剂（维生素K拮抗剂）和抗血小板药物（例如阿司匹林）。1998年，对于因标准肝素导致肝素诱导的血小板减少症的患者，不推荐使用低分子量肝素。
必须立即停用普通肝素或低分子量肝素。应咨询血液学实验室。必须记住，在开始肝素治疗时，基于对获益/风险比的仔细评估进行预防至关重要。
