肝素诱导的血小板减少症的临床观察

目的 分析静脉血栓栓塞症肝素诱导的血小板减少症及其治疗.方法 对我院2006年5月至2008年5月临床确诊并以肝素抗凝治疗的静脉血栓栓塞症患者202例进行临床分析,定期监测血常规.结果 其中有6例患者发生肝素诱导的血小板减少症,在应用肝素第3～9天出现血小板数目下降,发生率为2.97%,其下降率为60.4%～82.2%.对需要继续抗凝的4例患者停用肝素后改为阿加曲班继续治疗,第3～7天血小板数目回升至入院时水平.结论 在使用肝素进行抗凝治疗期间,应常规监测血小板数目变化,如发现血小板数目进行性下降大于50%,应及时停用肝素,需继续抗凝的患者可改用阿加曲班治疗.

Clinical observation of heparin-induced thrombocytopenia

Objective To explore the treatment of heparin-induced thrombocytopenia (HIT) in venous thromboembolism.Methods A total of 202 patients with venous thromboembolism without anticoagulation contraindications were enrolled. All of them were treated with low molecular weight heparin (LMWH) and/or unfractionated heparin (UFH). The peripheral blood cells were examined regularly.Results HIT occurred in 6 patients. And argatroban was used to treat HIT. The overall incidence rate of HIT in this study was 2.97%. The time of occurrence of HIT was about Days 3-9 after using heparin. The platelet recovered to the basic level at Days 3-7 after withdrawing heparin and initiating argatroban.Conclusion The count of platelet should be measured in the patients receiving regular LMWH and/or UFH therapy. And the above regimen should be discontinued timely when the platelet count declined progressively by over 50%. Argatroban was effective.