达肝素钠引起血小板减少合并动脉血栓形成

Dalteparin sodium-induced thrombocytopenia and arterial thrombosis

1例64岁男性患者因膀胱鳞状细胞癌行腹腔镜下膀胱癌根治性切除术,术后给予达肝素钠注射液5000 U皮下注射、1次/d抗凝治疗。第8天,患者血小板计数(PLT)从术前132×10^(9)/L降至65×10^(9)/L。第10天,患者出现左侧大腿乏力、肿胀、皮温低、皮肤发绀;PLT 22×10^(9)/L,血清肝素/血小板因子4复合物抗体检测呈阳性,左下肢CT血管造影示左侧髂总动脉血栓形成,诊断为肝素诱导的血小板减少症伴血栓形成。停用达肝素钠,改用磺达肝癸钠7.5 mg皮下注射、1次/d。2 d后患者左侧大腿肿胀等症状好转,PLT 62×10^(9)/L;8 d后患者左下肢肿胀消退,PLT恢复正常(128×10^(9)/L);18 d后左下肢CT血管造影提示左侧髂总动脉血栓部位血管再通,PLT 185×10^(9)/L。

A 64-year-old male patient underwent laparoscopic radical cystectomy for bladder squamous cell carcinoma,followed by anticoagulant therapy with subcutaneous injection of dalteparin sodium injection 5000 U once daily.On the 8th day of dalteparin sodium treatment,the patient developed thrombocytopenia[platelet count(PLT)decreased from 132×10^(9)/L before operation to 65×10^(9)/L after operation];on the 10th day,the patient developed weakness,swelling,and low skin temperature and cyanosis in the left thigh.Laboratory tests showed PLT 22×10^(9)/L and positive serum heparin/platelet factor 4 complex antibody.CT angiography of the left lower limb showed thrombosis of the left arteria iliaca communis.Heparin-induced thrombocytopenia with thrombosis was diagnosed.Dalteparin sodium was discontinued and replaced by subcutaneous injection of fondaparinux sodium 7.5 mg once daily.Two days later,the swelling in the left thigh was relieved and PLT was 62×10^(9)/L;8 days later,the swelling of left lower limb subsided and PLT was 128×10^(9)/L;18 days later,CT angiography of the left lower limb showed that the location of thrombus in the left arteria iliaca communis was partially recanalized and PLT was 185×10^(9)/L.