肝素诱导血小板减少症2例

Heparin-induced thrombocytopenia:two case reports

例1为24岁男性患者,因急性心肌梗死,给予阿司匹林300mg、氯吡格雷300mg口服和普通肝素10000U静脉推注,并行冠状动脉造影、经皮冠状动脉腔内成形术及支架植入术。患者术前血小板计数为228.0×10~9/L,术后1h降至36.2×10~9/L。考虑为肝素诱导的血小板减少,遂停用肝素,给予阿加曲班0.5～2μg·kg^(-1)·min^(-1)静脉滴注。第3天患者血小板升至101×10~9/L,第4天恢复正常。例2为69岁男性冠状动脉粥样硬化性心脏病患者,在冠状动脉造影术中静脉推注普通肝素3000U。之后,行冠状动脉搭桥术,术前连续7d给予低分子肝素(1mg·kg^(-1)·12h^(-1))皮下注射,术中给予普通肝素7000U静脉滴注。术前患者血小板计数197.0×10~9/L,术后降至19.2×10~9/L。停用肝素,给予阿加曲班0.5～1.5μg·kg^(-1)·min^(-1)静脉滴注,血小板计数升至146.0×10~9/L。

Patient 1, a 24-year-old man, received aspirin 300 mg, clopidogrel 300 mg, and an IV push of heparin 10 000 U , then he underwent coronary arteriography, percutaneous transluminal angioplasty and stenting for acute myocardial infarction. His platelet count was 228.0 ×10^9/L before surgery. One hour after surgery, his platelet count decreased to 36.2×10^9/L. Heparin-induced thrombocytopenia was considered. Subsequently, heparln was discontinued, and an IV infusion of argatroban 0.5-2μg·kg-1·min-1 was given. On day 3, the patient＇s platelet count increased to 101 ×10^9/L and, on day 4, the platelet count returned to normal range. Patient 2, a 69-year-old man, with coronary atherosclerotic cardiopathy received an IV push of heparin 3000 U during coronary arteriography. Subsequently, he underwent coronary bypass. SC low-molecular-weight heparin 1 mg · kg-1 · 12 h-1 was given for 7 days before surgery and an IV infusion of heparin 7000 U was given during surgery. His platelet count was 197 ×10^9/L before surgery and decreased to 19.2×10^9/L after surgery. Heparin was stopped and an IV infusion of argatroban 0.5-1.5μg·kg-1·min-1 was given. His plateht count increased to 146.0 ×10^9/L.