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1、肝素誘導(dǎo)的血小板減少癥史旭波首都醫(yī)科大學(xué)同仁醫(yī)院XIaXIIaIXaVIIa-III組織因子途徑抑制物抗凝血酶IIa纖維蛋白原纖維蛋白蛋白C，蛋白S系統(tǒng)XaVIIIaVa內(nèi)源性凝血系統(tǒng)外源性凝血系統(tǒng)凝血與抗凝系統(tǒng)Epidemiologythechanceofsignificantexposuretoheparinexceeds50%inhospitalizedpatientsacutecoronarysyndrome(UA/MI)pulmonaryembolismdeepvenousthrombosisan
2、dprophylaxisatrialfibrillation/strokeheparinizedpulmonarywedgecathetersPCIIABPSemiThrombHemost1999;25Suppl1:57-60U.S.EstimatedCausesofAccidentalDeaths〈100040,00090,000DeathsperyearMedicationErrors–HospitalAudit%REFERENCE血小板減少癥（HIT/HITS）美國每年有1200萬人因肢體或肺部血栓、
3、心臟病或血管成型術(shù)而接受肝素治療36萬人發(fā)生HIT12萬人出現(xiàn)血栓并發(fā)癥（靜脈、動脈）3.6萬人死亡Heparin-inducedThrombocytopeniaHeparin-inducedthrombocytopenia(HIT),anantibody-mediatedsyndrome,isassociatedwithsignificantmorbidityandmortalityconsideredararityinthepastunrecognizedbymanycliniciansdiagnose
4、scanbedifficulttoconfirmuntilrecentlytherewasnotherapeuticoptionsotherthandiscontinuationofheparinEpidemiologythrombocytopeniaisoneofthemostcommonlaboratoryabnormalitiesfoundamonghospitalizedpatientsserologicallyprovenHIToccursin1.5%to3%ofpatientswithhepar
5、inexposureNEnglJMed1995;332:1330-5CascadeofeventsleadingtoformationofHITantibodiesandprothromboticcomponentswww.thrombosite.comBleedingandClottingthemostfearedconsequenceinthesepatientswithalowplateletcountisnotbleedingbutclottingpresentwithmucocutaneousbl
6、eeding,rangingfrompetechiaeandecchymosestolife-threateninggastrointestinalandintracranialhemorrhageThrombosisthrombosisismostlyvenousnotarterialmayresultinbilateraldeepvenousthrombosisofthelegspulmonaryembolismvenousgangreneoffingers,toes,penis,ornipplesmy
7、ocardialinfarction,strokemesentericarterialthrombosislimbischemiaandamputationCirculation1999;100:587-93 AmJMed1996;101:502-7ThrombHaemost1993;70:554-61OtherClinicalFeaturesSkinlesionsatheparininjectionsiteSkinnecrosisAcuteplateletactivationAcuteinflammato
8、ryreactions(fever,chills,etc.)SkinNecrosisUsedwithpermissionfromWarkentinTE.BrJHaematol.1996;92:494–497.VenousLimbGangreneUsedwithpermissionfromWarkentinTE,ElavathilLJ,HaywardCPM,JohnstonMA,RussettJI,KeltonJG
