Robinson J A, Lewis B E
Loyola University Medical Center, Maywood, IL 60153, USA.
Semin Hematol. 1999 Jan;36(1 Suppl 1):29-32.
This study investigated the role of plasmapheresis in the treatment of severe heparin-induced thrombocytopenia (HIT). Patients diagnosed with HIT were divided into three experimental groups. Sixteen patients did not receive plasmapheresis (control). Twenty-one patients received plasmapheresis within 4 days of onset of thrombocytopenia (early group). Seven patients received plasmapheresis 4 days or later after onset (late group). Most patients underwent a second plasmapheresis 24 to 48 hours after the first, when clinically indicated, and platelet aggregation tests became negative in 75% of these patients. Heparin administration was discontinued after 1.4 days in the early group of patients and 4.2 days in the late group, as compared with 2.4 days in the control group. The 30-day mortality rate was 4.8% among patients in the early group and 57% in the late group, as compared with 32% in the control group. Platelet recovery time, incidence of thrombotic events, and length of hospital stay were similar in the early group and controls, but were somewhat higher in the late group. Thus, plasmapheresis within 4 days of the onset of thrombocytopenia reduced mortality in HIT patients, whereas plasmapheresis after 4 days was not beneficial. There were no adverse events related to plasmapheresis. These findings suggest that plasmapheresis may be useful in the treatment of HIT when initiated within 4 days of onset of thrombocytopenia.
本研究调查了血浆置换在治疗严重肝素诱导的血小板减少症（HIT）中的作用。诊断为HIT的患者被分为三个实验组。16名患者未接受血浆置换（对照组）。21名患者在血小板减少症发作后4天内接受了血浆置换（早期组）。7名患者在发作后4天或更晚接受了血浆置换（晚期组）。大多数患者在首次血浆置换后24至48小时（根据临床指征）进行了第二次血浆置换，其中75%的患者血小板聚集试验转为阴性。早期组患者在1.4天后停用肝素，晚期组在4.2天后停用，而对照组为2.4天。早期组患者的30天死亡率为4.8%，晚期组为57%，而对照组为32%。早期组和对照组的血小板恢复时间、血栓形成事件发生率和住院时间相似，但晚期组略高。因此，血小板减少症发作后4天内进行血浆置换可降低HIT患者的死亡率，而4天后进行血浆置换则无益处。没有与血浆置换相关的不良事件。这些发现表明，血小板减少症发作后4天内开始进行血浆置换可能对治疗HIT有用。
