HEPARIN-INDUCED THROMBOCYTOPENIA：heparin-induced血小板减少症.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * HEPARIN-INDUCED THROMBOCYTOPENIA Jeffrey M. Miller, MD Assistant Clinical Professor of Medicine Olive View - UCLA Medical Center Heparin-Induced Thrombocytopenia Heparin-induced thrombocytopenia (HIT) is a transient prothrombotic disorder initiated by heparin Main features: Thrombocytopenia resulting from IgG–mediated platelet activation In vivo thrombin generation and increased risk of venous and arterial thrombosis Warkentin TE. Hematology. 2003;503-509. HIT: Clinical Findings Thrombocytopenia with or without new thrombosis1,2 Skin lesions at heparin injection sites1,2 Acute systemic reactions (chills, cardio-respiratory distress) after IV heparin bolus administration2 Strong association with venous and arterial thrombosis2 Absolute thrombosis risk2: 30% – 75% Depends on the patient population 1. Warkentin TE, Greinacher A. Chest. 2004;126:311S-337S. 2. Warkentin TE. Hematology. 2003;503-509. HIT: Serologic Findings Positive test for HIT antibodies Diagnostic specificity can be increased by use of a sensitive washed platelet activation assay More specific than a positive antigen assay Warkentin TE, Greinacher A. Chest. 2004;126:311S-337S. Frequency of HIT Risk of HIT with respect to type of heparin Bovine lung unfractionated heparin (UFH) Porcine mucosal UFH Low–molecular weight heparin (LMWH) Risk of HIT increases each day that heparin continues beyond day 4 Immunization risk declines after day 10 Warkentin TE. Hematology. 2003;503-509. Frequency of HIT (cont) Risk of HIT with respect to patient population Surgical Medical Obstetrical Highest frequency of HIT, 5%, has been reported in post-orthopedic surgery patients receiving up to 2 weeks of UFH HIT occurred in about 0.5% of post-orthopedic surgery patients receiving LMWH for up to 2 weeks Warkentin TE. Hematology. 2003;503-509. Pathophysiology of HIT PF4 is a platelet-specific C-X-C chemokine Released in high concentrations