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1、肝素诱导的血小板减少症史旭波首都医科大学同仁医院XIaXIIaIXaVIIa-III组织因子途径抑制物抗凝血酶IIa纤维蛋白原纤维蛋白蛋白C，蛋白S系统XaVIIIaVa内源性凝血系统外源性凝血系统凝血与抗凝系统Epidemiologythechanceofsignificantexposuretoheparinexceeds50%inhospitalizedpatientsacutecoronarysyndrome(UA/MI)pulmonaryembolismdeepvenousthrombosisandprophylaxisatrialfi
2、brillation/strokeheparinizedpulmonarywedgecathetersPCIIABPSemiThrombHemost1999;25Suppl1:57-60U.S.EstimatedCausesofAccidentalDeaths〈100040,00090,000DeathsperyearMedicationErrors–HospitalAudit%REFERENCE血小板减少症（HIT/HITS）美国每年有1200万人因肢体或肺部血栓、心脏病或血管成型术而接受肝素治疗36万人发生HIT12万人出现血栓并发症（静脉、
3、动脉）3.6万人死亡Heparin-inducedThrombocytopeniaHeparin-inducedthrombocytopenia(HIT),anantibody-mediatedsyndrome,isassociatedwithsignificantmorbidityandmortalityconsideredararityinthepastunrecognizedbymanycliniciansdiagnosescanbedifficulttoconfirmuntilrecentlytherewasnotherapeuticop
4、tionsotherthandiscontinuationofheparinEpidemiologythrombocytopeniaisoneofthemostcommonlaboratoryabnormalitiesfoundamonghospitalizedpatientsserologicallyprovenHIToccursin1.5%to3%ofpatientswithheparinexposureNEnglJMed1995;332:1330-5CascadeofeventsleadingtoformationofHITantibodi
5、esandprothromboticcomponentswww.thrombosite.comBleedingandClottingthemostfearedconsequenceinthesepatientswithalowplateletcountisnotbleedingbutclottingpresentwithmucocutaneousbleeding,rangingfrompetechiaeandecchymosestolife-threateninggastrointestinalandintracranialhemorrhageT
6、hrombosisthrombosisismostlyvenousnotarterialmayresultinbilateraldeepvenousthrombosisofthelegspulmonaryembolismvenousgangreneoffingers,toes,penis,ornipplesmyocardialinfarction,strokemesentericarterialthrombosislimbischemiaandamputationCirculation1999;100:587-93 AmJMed1996;101:
7、502-7ThrombHaemost1993;70:554-61OtherClinicalFeaturesSkinlesionsatheparininjectionsiteSkinnecrosisAcuteplateletactivationAcuteinflammatoryreactions(fever,chills,etc.)SkinNecrosisUsedwithpermissionfromWarkentinTE.BrJHaematol.1996;92:494–497.VenousLimbGangreneUsedwithpermission
8、fromWarkentinTE,ElavathilLJ,HaywardCPM,JohnstonMA,RussettJI,KeltonJG
