肝素临床应用并发症与防治

Complications of heparin therapy:a contemporary clinical approach to prevention and treatment

肝素作为抗凝药之一,能有效预防和治疗大多数血栓栓塞性疾病。肝素应用最常见的并发症是出血,出血的程度由轻度的黏膜出血、皮下渗血和血尿到广泛性颅内、胃肠道、后腹膜及泌尿道出血。使用抗凝治疗者存在6%～10%出血并发症危险;若病人合并肾功能衰竭、凝血功能障碍以及血小板减少时,出血并发症可高达50%。非致命性出血的最佳治疗是停用肝素。如出血仍然存在,可使用鱼精蛋白中和肝素。肝素第二个潜在危及生命或肢体的并发症是肝素诱导的血小板减少症(HIT)。一旦拟诊HIT,立即终止肝素使用,并使用非肝素类抗凝剂。

Anticoagulation with heparin has been proven effective for the prevention and treatment of most thromboembolic diseases. The most common complication of heparin therapy is hemorrhage, which may vary fl＇om mild mucosal oozing or hematuria to extensive intracranial, gastrointestinal, retroperitoneal, or urinary, bleeding. There is a 6%-10% risk of bleeding complications when anticoagulation is in the therapeutic range. The incidence of hemorrhage may approach 50% in patients with renal failure, underlying hemostatic defects, or thrombocytopenia. Hemorrhage that is not life-threatening is best managed by discontinuation of heparin therapy. If bleeding continues, heparin may be neutralized with protamine sul- fate. Heparin induced thrombocytopenia （HIT） in addition to bleeding complications is the most serious and dangerous side effect of heparin therapy. If HIT is likely, heparin must be im- mediately discontinued in the any form, even in absence of certain diagnosis of HIT, followed by pharmacologic inhibition with thrombin.