Poullin P, Pietri P A, Lefèvre P
Service d'hémaphérèse et d'autotransfusion, hôpital de La Conception, Marseille, France.
Rev Med Interne. 1998 Nov;19(11):819-22. doi: 10.1016/s0248-8663(98)80386-x.
Heparin-induced thrombocytopenia with thrombosis is a rare but severe adverse reaction to heparin therapy, whose management is difficult. After heparin withdrawal, the initiation of an alternative anticoagulant therapy, such as recombinant hirudin or danaparoid, is strongly recommended before vitamin K antagonists are effective. Several reports of the efficacity of plasma exchanges in patients with life-threatening thrombosis have been made.
We report on a patient with severe aortic thrombosis related to heparin therapy in whom a unique plasma exchange resulted in both dramatic improvement in the platelet count and marked reduction of the thrombosis.
This case provides further evidence that plasma exchanges can be useful in the management of heparin-induced thrombocytopenia with thrombosis. They are rapidly efficient and can be used before heparin alternative treatment is effective.
肝素诱导的血小板减少症伴血栓形成是肝素治疗罕见但严重的不良反应，其治疗困难。停用肝素后，强烈建议在维生素K拮抗剂起效前启动替代抗凝治疗，如重组水蛭素或达那肝素。已有数篇关于血浆置换对危及生命的血栓形成患者疗效的报道。
我们报告了1例与肝素治疗相关的严重主动脉血栓形成患者，单次独特的血浆置换使血小板计数显著改善，血栓明显缩小。
该病例进一步证明血浆置换可用于肝素诱导的血小板减少症伴血栓形成的治疗。它们起效迅速，可在肝素替代治疗起效前使用。
