一例速发型肝素诱导的血小板减少症患者的病例分析

Case analysis of a patient with immediate heparin-induced thrombocytopenia

1例62岁女性患者因下肢动脉栓塞收入院,入院第7天行手术,术后给予肝素钠微量泵泵入抗凝,尿激酶微量泵泵入溶栓,继续降脂、保肝、抗贫血治疗。启动肝素用药24 h内血小板计数从330×10^9/L下降至82×10^9/L,最低值为48×10^9/L。停用肝素后给予阿加曲班替代抗凝治疗,患者血小板计数3 d后升高至正常范围。根据APTT水平调整阿加曲班注射液泵速,持续泵入。下肢动脉栓塞病情加重未缓解。患者行截肢手术,术后使用阿司匹林抗血小板,利伐沙班维持抗凝治疗。患者病情稳定,8 d后出院。

A 62-year-old female patient was admitted to the hospital for lower extremity arterial embolization.The patient underwent surgery on the 7 th day after admission.Heparin sodium micro pump was used for anticoagulation,urokinase micropump for thrombolysis,and lipid-lowering,hepatoprotective and anemia treatments were continued.The platelet count decreased from 330×10^9/L to 82×10^9/L within 24 hours after starting heparin administration,and the lowest value was 48×10^9/L.After heparin was stopped,argatroban was given instead,then the platelet count increased to the normal range after 3 days.The pump speed of argatroban injection was adjusted according to the APTT level and the pumping was continued.The exacerbation of lower extremity arterial embolism was not relieved.Amputation surgery was conducted.Aspirin was used for antiplatelet postoperatively,and rivaroxaban was maintained for anticoagulant therapy.The patient was stable,and was discharged after 8 days.