临床误诊误治2017，Vol.30Issue(1)：69-72,4.DOI:10.3969/j.issn.1002-3429.2017.01.024
PCI术后发生肝素诱导血小板减少症并下肢静脉血栓形成及脑出血
Heparin-induced Thrombocytopenia Combined with Venous Thrombosis of Lower Limbs and Cerebral Hemorrhage after PCI Surgery
程京华 1闵煜榕 1彭永平 1宫剑滨1
作者信息
- 1. 210002 南京，南京军区南京总医院心脏内科
- 折叠
摘要
Abstract
Objective To improve the diagnosis and awareness of heparin-induced thrombocytopenia( HIT)in order to avoid misdiagnosis and mistreatment. Methods Clinical data of a patient with low molecular HIT was retrospectively ana-lyzed,and relative literature was reviewed. Results The patient with acute inferior wall right ventricular myocardial infarction received Aspirin,Ticagrelor,Eptifibatide and low molecular heparin treatments after undergoing percutaneous coronary inter-vention( PCI ). Widely peripheral venous thrombosis was found on postoperative 15 days. Anticoagulation treatment was changed to 75 mg Clopidogrel with once daily by orally and 4000 U low molecular heparin by one time for every 12 h by subcu-taneous injections,and then right occipital hemorrhage was found,and platelet count was rapidly decreased more than 50﹪ 2 days later. The patient was diagnosed as having type Ⅱ HIT according to the 4Ts score standard. The platelet count gradually improved when the anticoagulant drugs were changed to Fondaparinux Sodium and( or)Dabigatran ester. The platelet recov-ered to normal 7 months later. Conclusion HIT is rare and latent,so clinicians should highly suspect HIT for patients with decreasing platelet count after anticoagulant treatment with containing heparin drugs. Clinical evaluation and medical examina-tions should be performed early so as to confirm diagnosis and treatment as early as possible.关键词
肝素/药物毒性/血小板减少/静脉血栓形成/脑出血Key words
Heparin/Drug toxicity/Thrombocytopenia/Venous thrombosis/Cerebral hemorrhage分类
医药卫生引用本文复制引用
程京华,闵煜榕,彭永平,宫剑滨..PCI术后发生肝素诱导血小板减少症并下肢静脉血栓形成及脑出血[J].临床误诊误治,2017,30(1):69-72,4.
