1例低分子肝素诱导血小板减少的肺栓塞患者的药学监护

Pharmaceutical care on a pulmonary thromboembolism patient with thrombocytopenia induced by low molecular heparin

对1例肺栓塞患者应用低分子肝素治疗引起血小板减少(HIT)用药过程进行分析,检索近年来国内外HIT相关文献,结合本病例进行关联性评价,总结治疗药物选择的新进展,指导临床正确选择与使用抗凝药物。根据国家ADR中心制定的关联性评价标准,本例患者ADR关联性评价为很可能,4T's评分系统评价结果为高度可能。一旦发生HIT应停用肝素(包括肝素冲管);使用非肝素药物进行抗凝,如阿加曲班、达那肝素、比伐卢定、磺达肝葵钠及新型口服抗凝药;急性HIT治疗时华法林为禁忌证,此时使用华法林会导致四肢静脉坏疽,需待血小板计数恢复(>150×109·L^(-1))后再开始使用。

To summarize the key points of pharmaceutical care on a pulmonary thromboembolism patient with heparin-induced thrombocytopenia(HIT). Literature concerning HIT published in domestic and international journals were reviewed. The ADR relevance of the example was evaluated, and the treatment progress of anticoagulant drugs was summarized, which could guide the selection and usage of anticoagulant drugs in clinic. According to the relevance evaluation criterion formulated by national ADR monitoring center, the relevance evaluation results was possible, while the result was highly possible evaluated by 4T's scoring system. Heparin should be discontinued(including heparin flushing) when HIT occurred, and non-heparin anticoagulant drugs could be used, such as argatroban, danaparoid, bivalirudin, fondaparinux sodium and new oral anticoagulants. Warfarin is the contraindication in the treatment of acute HIT, which can lead to limb vein necrosis, and warfarin could be reused when the platelet count recovered(150×109·L^(-1)).