肝素诱导的血小板减少症（学习资料）.pptVIP

肝素诱导的血小板减少症 史旭波 首都医科大学同仁医院 Epidemiology the chance of significant exposure to heparin exceeds 50% in hospitalized patients acute coronary syndrome (UA / MI) pulmonary embolism deep venous thrombosis and prophylaxis atrial fibrillation / stroke heparinized pulmonary wedge catheters PCI IABP U.S. Estimated Causes of Accidental Deaths Medication Errors – Hospital Audit 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HIT 12万人出现血栓并发症（静脉、动脉） 3.6万人死亡 Heparin-induced Thrombocytopenia Heparin-induced thrombocytopenia (HIT), an antibody-mediated syndrome, is associated with significant morbidity and mortality considered a rarity in the past unrecognized by many clinicians diagnoses can be difficult to confirm until recently there was no therapeutic options other than discontinuation of heparin Epidemiology thrombocytopenia is one of the most common laboratory abnormalities found among hospitalized patients serologically proven HIT occurs in 1.5% to 3% of patients with heparin exposure Cascade of events leading to formation of HIT antibodies and prothrombotic components Bleeding and Clotting the most feared consequence in these patients with a low platelet count is not bleeding but clotting present with mucocutaneous bleeding, ranging from petechiae and ecchymoses to life-threatening gastrointestinal and intracranial hemorrhage Thrombosis thrombosis is mostly venous not arterial may result in bilateral deep venous thrombosis of the legs pulmonary embolism venous gangrene of fingers, toes, penis, or nipples myocardial infarction, stroke mesenteric arterial thrombosis limb ischemia and amputation Other Clinical Features Skin lesions at heparin injection site Skin necrosis Acute platelet activation Acute inflammatory reactions (fever, chills, etc.) Skin Necrosis Used with permission from Warkentin TE. Br J Haematol. 1996;92:494–497. Venous Limb Gangrene Morbidity and Mortality HIT-associated mortality is high (about 18%) 5% of affected pati