Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis.
Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis.
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DOI：
10.1155/2018/9501863
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发表时间：
2018
影响因子：
0.7
通讯作者：
Green D
中科院分区：
文献类型：
--
作者：
Sunseri M;Ahuja T;Wilcox T;Green D
普通肝素和低分子肝素通常用于住院患者的血栓预防。尽管通常认为预防性剂量是安全的，但也有灾难性出血的报道。所提出的机制涉及肝素的生物积累，通过饱和其代谢中的快速消除途径。我们提出一个不寻常的病例，一个中等体重的转移性黑色素瘤患者，在每天服用三次普通肝素预防性治疗时，发生出血并伴有晕厥和终末器官损害。凝血试验与肝素毒性一致。尽管给予鱼精蛋白，肝素的清除明显延迟，正如一系列凝血研究所证明的那样。我们回顾了肝素生物蓄积的可疑危险因素，以及对这一涉及几乎无处不在的药物的不同寻常的不良事件的新认识。
Unfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through saturation of the rapid-elimination pathway in its metabolism. We present an unusual case of an average-weight man with metastatic melanoma who suffered hemorrhage with syncope and end-organ damage while on prophylactic three times daily unfractionated heparin. Coagulation studies were consistent with heparin toxicity. Despite administration of protamine, the clearance of heparin was remarkably delayed, as demonstrated by serial coagulation studies. We review the suspected risk factors for heparin bioaccumulation and the emerging understanding of this unusual adverse event involving a nearly ubiquitous medication.