Heparin-Induced Thrombocytopenia in Cardiac Surgery Patients.
Heparin-Induced Thrombocytopenia in Cardiac Surgery Patients.
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DOI：
10.1055/s-0037-1602664
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发表时间：
2017-10
影响因子：
5.7
通讯作者：
Cuker A
中科院分区：
文献类型：
--
作者：
Pishko AM;Cuker A
肝素诱导的血小板减少症（HIT）是由靶向血小板因子4（PF 4）和肝素复合物的血小板活化抗体介导的促血栓形成疾病。由于几乎所有接受心肺转流术（CPB）的患者都暴露于肝素，并经历术后血小板计数下降，因此在该人群中通常怀疑HIT并不奇怪。然而，术中和术后接受普通肝素的心脏手术患者的HIT发生率远低于疑似HIT的发生率，约为1%至2%。因此，临床诊断可能特别具有挑战性，因为需要区分与CPB和手术相关的常见血小板计数下降与不太常见的与HIT相关的血小板计数下降。双相血小板计数模式是HIT的特征。实验室诊断也很困难，因为在没有HIT的患者中，心脏手术后抗PF 4/肝素抗体血清阳性的频率很高。心脏手术环境中管理的一个独特方面是为需要心脏手术的有HIT病史的患者选择术中使用的抗凝剂。在这篇文章中，我们回顾了心脏手术患者HIT的流行病学、临床诊断和实验室诊断，并提出了一个概念框架，用于选择有HIT病史的患者的术中抗凝治疗。
Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder mediated by platelet-activating antibodies that target complexes of platelet factor 4 (PF4) and heparin. Because nearly all patients undergoing cardiopulmonary bypass (CPB) are exposed to heparin and experience a postoperative platelet count fall, it is not surprising that HIT is commonly suspected in this population. However, the incidence of HIT in cardiac surgery patients who receive intraoperative and postoperative unfractionated heparin is much lower than the incidence of suspected HIT, being approximately 1 to 2%. Clinical diagnosis may therefore be particularly challenging because of the need to distinguish the common platelet count fall associated with CPB and surgery from the much less common platelet count fall associated with HIT. A biphasic platelet count pattern is characteristic of HIT in this setting. Laboratory diagnosis is also difficult because of the high frequency of anti-PF4/heparin antibody seropositivity after cardiac surgery in patients without HIT. A unique aspect of management in the cardiac surgery setting is selecting an anticoagulant for intraoperative use in patients with a history of HIT who require cardiac surgery. In this article, we review the epidemiology, clinical diagnosis, and laboratory diagnosis of HIT in cardiac surgery patients and present a conceptual framework for selecting intraoperative anticoagulation in patients with a history of HIT.
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影响因子：
20.3
作者：
Cuker, Adam;Gimotty, Phyllis A.;Warkentin, Theodore E.
通讯作者：
Warkentin, Theodore E.
影响因子：
20.3
作者：
Cuker, Adam;Cines, Douglas B.
通讯作者：
Cines, Douglas B.
DOI：
10.1016/j.jtcvs.2005.09.057
发表时间：
2006-03-01
影响因子：
6
作者：
Dyke, CM;Smedira, NG;Spiess, BD
通讯作者：
Spiess, BD
DOI：
10.1016/j.jamcollsurg.2011.04.002
发表时间：
2011-07-01
影响因子：
5.2
作者：
Berry, Cherisse;Tcherniantchouk, Oxana;Margulies, Daniel R.
通讯作者：
Margulies, Daniel R.
影响因子：
6.5
作者：
Bryant, Adam;Low, Joyce;Joseph, Joanne E.
通讯作者：
Joseph, Joanne E.