HEPARIN-INDUCED THROMBOCYTOPENIA - University of heparin-induced血小板减少-大学

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1、HEPARININDUCEDTHROMBOCYTOPENIA(HIT)HEPARIN-INDUCEDTHROMBOCYTOPENIAUnfractionatedheparin(UFH)(beef>pork)ContinuousivinfusionCardiopulmonarybypassLowdosesqHeparinflushesHeparin-bondedcathetersLowmolecularweightheparinMorelikelytocauseHITifptpreviouslyexpose

2、dtoUFHCausativeagentsHEPARIN-INDUCEDTHROMBOCYTOPENIAIsolatedthrombocytopenia(“IsolatedHIT”)Arterialorvenousthrombosis(HITT)DVT,PE,MI,stroke,peripheralarterialocclusionDIC,microangiopathichemolyticanemiaSkinnecrosis(atinjectionsitesordistant)Venouslimbgangr

3、ene(?Roleofwarfarin)SuddendeathARDSHemorrhagicadrenalinfarctionClinicalmanifestationsHEPARIN-INDUCEDTHROMBOCYTOPENIAUFH>LMWH>>FondaparinuxDurationofheparintreatment≥6daysRarelyoccursinpatients<40yearsold2-3foldhigherincidenceinwomenSurgical>medical>obstetr

4、icpatientsIncidenceintraumapatientsproportionaltoseverityoftraumaRelatedtodegreeofplateletactivation?EpidemiologyBlood2012;119:2209HEPARIN-INDUCEDTHROMBOCYTOPENIAPresentingwiththrombosis(n=65)Presentingwithnothrombosis(n=62)Total(n=127)Age67±10.766.7±12.36

5、7.0±11.4Male/Female27/3833/2960/67SURGICALPTS513384(66.1%)Orthopedic251540Cardiovascular10919Oncology7613General628Neurosurgery314MEDICALPTS142943(33.9%)Cardiac61016DVTorPE4711Other41216IncidenceandpresentingfeaturesWarkentinandKelton,AmJMed1996;101:502THR

6、OMBOTICCOMPLICATIONSINHITTypeofthrombosisPtspresentingwiththrombosis(n=65)Ptspresentingwithonlythrombocytopenia(n=62)VENOUS(n=78)5424DVT(n=61)4021New3521Progression40Recurrence10PE(n=32)266New255Recurrence11ARTERIAL(n=18)126Limb72Myocardialinfarct31Thrombo

7、ticstroke23Other(n=3)12Suddendeath01Adrenalhemorrhage11NOTHROMBOSIS(n=30)NA30AmJMed1996;101:502ISOLATEDHITISASSOCIATEDWITHAHIGHRISKOFSUBSEQUENTTHROMBOSISAmJMed1996;101:502Over50%ofpatientspresentingwith“isolatedHIT”hadasubsequentthromboticepisodewithin30da

8、ysSubstitutionofwarfarinforheparinaftertheonsetofthrombocytopeniadidnotpreventthrombosisUNFRACTIONATEDHEPARINISMORELIKELYTOCAUSEHITTHANLMWHRandomizedtrialinptshavinghipsurgeryWarkentinetal,NEJM1995;332:1330Wa