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1、肝素誘導的血小板減少癥史旭波首都醫(yī)科大學同仁醫(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)pulmonaryembolismdeepvenousthrombosisandprophylaxisatrialfi
2、brillation/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、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、
3、動脈）3.6萬人死亡Heparin-inducedThrombocytopeniaHeparin-inducedthrombocytopenia(HIT),anantibody-mediatedsyndrome,isassociatedwithsignificantmorbidityandmortalityconsideredararityinthepastunrecognizedbymanycliniciansdiagnosescanbedifficulttoconfirmuntilrecentlytherewasnotherapeuticop
4、tionsotherthandiscontinuationofheparinEpidemiologythrombocytopeniaisoneofthemostcommonlaboratoryabnormalitiesfoundamonghospitalizedpatientsserologicallyprovenHIToccursin1.5%to3%ofpatientswithheparinexposureNEnglJMed1995;332:1330-5CascadeofeventsleadingtoformationofHITantibodi
5、esandprothromboticcomponentswww.thrombosite.comBleedingandClottingthemostfearedconsequenceinthesepatientswithalowplateletcountisnotbleedingbutclottingpresentwithmucocutaneousbleeding,rangingfrompetechiaeandecchymosestolife-threateninggastrointestinalandintracranialhemorrhageT
6、hrombosisthrombosisismostlyvenousnotarterialmayresultinbilateraldeepvenousthrombosisofthelegspulmonaryembolismvenousgangreneoffingers,toes,penis,ornipplesmyocardialinfarction,strokemesentericarterialthrombosislimbischemiaandamputationCirculation1999;100:587-93 AmJMed1996;101:
7、502-7ThrombHaemost1993;70:554-61OtherClinicalFeaturesSkinlesionsatheparininjectionsiteSkinnecrosisAcuteplateletactivationAcuteinflammatoryreactions(fever,chills,etc.)SkinNecrosisUsedwithpermissionfromWarkentinTE.BrJHaematol.1996;92:494–497.VenousLimbGangreneUsedwithpermission
8、fromWarkentinTE,ElavathilLJ,HaywardCPM,JohnstonMA,RussettJI,KeltonJG
