Schmidt O, Lang W
Chirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
Dtsch Med Wochenschr. 1998 Oct 9;123(41):1207-10. doi: 10.1055/s-2007-1024144.
A 60-year-old woman was admitted because of acute ischemia of the right leg. The patient had been immobilized during diagnostic procedures for a thoracic paraspinal space-occupying lesion and over 5 days had received unfractionated sodium heparin by subcutaneous injection. The pedal pulses were no longer palpable.
INVESTIGATIONS, DIAGNOSIS AND TREATMENT: The thrombocyte count had fallen from 207,000/microliter to 45,000/microliter. Angiography revealed occlusion of the common femoral artery. Heparin-induced platelet aggregation (HIPA) test demonstrated type II heparin-induced thrombocytopenia. Thrombectomy was performed and intraoperatively an i.v. bolus of the recombinant hirudin, lepirudin (Refludan), was given (0.2 mg/kg body weight), continual lepirudin infusion being continued postoperatively. Normal blood flow was re-established in the limb and the pedal pulse was palpable. There were no complications.
Recombinant hirudin is the only alternative licensed in Germany to heparin and seem to be suitable also for the intraoperative bolus administration in heparin-induced thromboembolic vascular occlusions.
一名60岁女性因右腿急性缺血入院。该患者在针对胸段脊柱旁占位性病变的诊断过程中一直处于制动状态，且在5天多的时间里接受了皮下注射普通肝素钠治疗。足背动脉搏动已无法触及。
检查、诊断及治疗：血小板计数从207,000/微升降至45,000/微升。血管造影显示股总动脉闭塞。肝素诱导的血小板聚集（HIPA）试验证实为II型肝素诱导的血小板减少症。进行了血栓切除术，术中静脉推注重组水蛭素——比伐芦定（Refludan）（0.2毫克/千克体重），术后持续输注比伐芦定。肢体血流恢复正常，足背动脉搏动可触及。无并发症发生。
重组水蛭素是德国唯一获得许可可替代肝素的药物，似乎也适用于肝素诱导的血栓栓塞性血管闭塞的术中静脉推注给药。
