新发Ⅱ型肝素诱导的血小板减少症及相关血栓的临床治疗  

Clinical treatment of new type Ⅱ heparin-induced thrombocytopenia and related thrombosis

作　　者：齐浩山[1] 赵俊成[1] 李大林[1] 颜京强[1] 梁刚柱 Qi Haoshan;Zhao Juncheng;Li Dalin;Yan Jingqiang;Liang Gangzhu(Department of Vascular Surgery,Qingdao Municipal Hospital,Qingdao 266000,Shandong,China;Department of Vascular Surgery,Centro Hospitalar Conde de São Januário,Macao Special Administrative Region 999078,China)

机构地区：[1]青岛市市立医院血管外科,山东青岛266000 [2]澳门仁伯爵综合医院血管外科,中国澳门特别行政区999078

出　　处：《血管与腔内血管外科杂志》2022年第3期353-356,362,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨利伐沙班治疗下肢动静脉血栓患者新发Ⅱ型肝素诱导的血小板减少症(HIT)及肝素诱导的血小板减少症伴血栓形成(HITT)的临床效果及安全性。方法收集2013年1月至2020年12月青岛市市立医院收治的21例下肢动静脉血栓伴有HITT的新发Ⅱ型HIT患者的临床资料,所有患者均采用利伐沙班进行治疗。观察患者的血小板上升水平和时间、D-二聚体水平变化;记录出血并发症的发生情况;随访血栓复发及吸收情况。结果与HIT发生前比较,HIT发生后的D-二聚体水平升高,血小板计数减少。经利伐沙班治疗后,D-二聚体水平呈逐渐下降趋势,血小板计数逐渐升高并恢复正常,不同时间点(HIT发生前、HIT发生后,以及治疗5 d后、10 d后、1个月后)D-二聚体水平和血小板计数两两比较,差异均有统计学意义(P<0.05)。随访6~12个月,21例患者的血小板均正常,未出现下肢动静脉血栓的延伸或复发,未发生主要和次要出血并发症。下肢动静脉血栓的完全再通率为76%(16/21),部分再通率为24%(5/21)。结论下肢动静脉血栓患者新发Ⅱ型HIT及HITT后口服利伐沙班替代抗凝治疗安全有效,为临床治疗HIT提供了便捷、有效的方法。Objective To explore the clinical efficacy and safety of rivaroxaban in the treatment of new type Ⅱ heparin-induced thrombocytopenia(HIT)and heparin-induced thrombocytopenia with thrombosis(HITT)in patients with lower extremity arteriovenous thrombosis.Method A total of 21 new type Ⅱ HIT patients with HITT were collected from the lower extremity arteriovenous thrombosis admitted to Qingdao Municipal Hospital from January 2013 to December 2020.All patients were treated with rivaroxaban.The patients'platelet rising level and time and the changes in D-dimer level were observed.The occurrence of bleeding complications was recorded,the recurrence and absorption of thrombus were followed up.Result The level of D-dimer increased and the platelet count decreased after HIT compared with that before HIT.After the treatment based on rivaroxaban,the level of D-dimer decreased and the platelet count increased to a normal level gradually.Pairwise comparison of D-dimer levels and platelet counts at different time points(before HIT,after HIT,and after 5 d,10 d,and 1 month of treatment)was statistically significant(P<0.05).During the follow-up period of 6 to 12 months,the platelets of 21 patients were normal,and there was no extension or recurrence of lower extremity arteriovenous thrombosis or major and minor bleeding complications.The complete recanalization rate of lower extremity arteriovenous thrombosis was 76%(16/21),and the partial recanalization rate was 24%(5/21).Conclusion After new HIT and HITT in patients with lower extremity arteriovenous thrombosis,oral rivaroxaban which provides a convenient and effective method for clinical treatment of HIT is safe and effective to replace anticoagulation.

关 键 词：血小板减少症 利伐沙班 肝素 动静脉血栓形成 抗凝治疗 

分 类 号：R543[医药卫生—心血管疾病]