阿加曲班防治肝素致血小板减少症诱发的血栓综合征4例临床观察

Clinical observation of Argatroban on thrombotic syndrome in 4 cases with heparin-induced thrombocytopenia

目的观察阿加曲班对4例肝素致血小板减少症的抗凝疗效。方法对临床确诊并以肝素进行抗凝治疗的202例静脉血栓栓塞症患者进行临床分析,定期监测血常规及凝血指标,以确定是否发生血小板减少症的不良反应。对其中4例肝素致血小板减少症患者,停用肝素,给以阿加曲班治疗,20mg/d,治疗3～7d。结果 4例肝素致血小板减少症患者换用阿加曲班后,血小板水平恢复至入院时水平,没有发生血栓综合征,同时患者下肢肿痛症状缓解速度快、疗效好。结论阿加曲班可替代肝素,有效预防肝素致血小板减少症继发的血栓综合征。

Objective To observe the anticoagulation of Argatroban on 4 cases with heparin-induced thrombocytopenia （HIT）. Methods A positive diagnosis for venous thromboembolism and anticoagulation contraindications in 202 cases was enrolled. All of them were treated with low molecular weight heparin （LMWH） and/or unfractionated heparin （UFH）. The peripheral blood cells and coagulation indexes were examined regularly to determine if the adverse reaction of thrombocytopenia occured. Four cases of heparin-induced thrombocytopenia stopped using heparin, while was treated with Argatroban （20 mg/d） instead for 3--7 d. Results The platelet recovered to the basic level after withdrawing heparin and initiating Argatroban, the thrombotic syndrome did not appear and the lower limb swelling in clinical symptoms could be relieved immediately. Conclusion Argatroban could effectively replace heparin to prevent the secondary thrombosis with HIT.