恶性肿瘤抗凝治疗后肝素诱导血小板减少症的诊断与治疗进展

Recent advances in diagnosis and treatment of heparin-induced thrombocytopenia after anticoagulant therapy for malignant tumor

恶性肿瘤患者多伴有凝血机制的异常，如血小板增多、血小板聚集功能亢进等，从而导致血栓发生，是恶性肿瘤最常见的并发症之一。根据发生血栓的流行病学调查显示，恶性肿瘤患者发生静脉血栓栓塞症（ VTE）的风险约为非恶性肿瘤患者的4～7倍。目前有关发生恶性肿瘤相关血栓的危险因素包括患者、恶性肿瘤及治疗相关因素，可根据恶性肿瘤相关血栓的生物学标志物及其危险模型进行评估，并对其进行预防及治疗。恶性肿瘤患者发生VTE一般采用肝素或低分子肝素治疗，但经肝素抗凝治疗后又常常发生血小板减少，导致患者的皮肤黏膜广泛出血及器官出血。因此，本文就恶性肿瘤相关血栓发生的原因、抗凝治疗后肝素诱导血小板减少症的临床和实验室诊断及其临床治疗进展作一综述，供血液肿瘤科的临床医师讨论和参考。

The coagulation mechanism is abnormal in malignant tumor patients, such as the increased platelet count and in-creased platelet aggregation. Therefore, the cancer associated thrombosis is one of the most common complication in malignant tumor patients. According to the epidemic investigation of maglignant tumor and thrombus, the risk of venous thromboembolism（VTE） is about 4-7 times higher in cancer patients than that of non-tumor patients. Risk factors for cancer associated thrombosis include tumor types, patients？ characteristics and treatment related factors. We can prevent and treat tumor associated thrombosis according to its bio-logical markers and risk models. The heparin or low molecular weight heparin is often applied in the treatment of cancer patients with VTE. But the thrombocytopenia often occurs after the treatment of heparin therapy, which causes the skin and organ extensive bleeding in cancer patients. Therefore, this paper will briefly review the pathogenesis of maglignat tumor associated thrombosis, the clinical and laboratory diagnosis of thrombocytopenia after the heparin treatment and the progress of clinical treatment, which can be useful for dis-cussion and reference for the clinicians.