Failure of Fondaparinux in Autoimmune Heparin-Induced Thrombocytopenia.
Failure of Fondaparinux in Autoimmune Heparin-Induced Thrombocytopenia.
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DOI：
10.1055/s-0040-1713175
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Cosmi B
中科院分区：
文献类型：
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作者：
Sartori M;Cosmi B
肝素诱导的血小板减少症（HIT）是肝素的一种免疫不良反应，与危及生命的血栓性并发症相关。更罕见的是，HIT可能在停用肝素或肝素冲洗后开始（自身免疫性HIT）。磺达肝癸钠已被提议作为HIT的候选治疗，但关于其在自身免疫性HIT中的应用的数据很少。一位86岁男性，有糖尿病、动脉高血压和高胆固醇血症病史，因颈动脉内膜切除术入院。在手术过程中，仅使用了一次肝素剂量5，000 U。血小板计数在术后第11天开始下降。由于患者未接受肝素治疗/预防，因此未怀疑HIT。第19天，血小板计数为61 × 103/μL，对患者进行了HIT诊断调查。免疫球蛋白（IG）-G特异性酶联免疫吸附试验（ELISA）呈阳性，通过血小板聚集试验证实HIT;开始磺达肝癸钠5 mg每日一次给药。磺达肝癸钠治疗期间，血小板计数未增加，发生下肢深静脉血栓形成。停用磺达肝癸钠，开始利伐沙班15 mg每日两次治疗。磺达肝癸钠停药10天后，血小板计数恢复至基线。利伐沙班治疗期间未发生血栓形成事件或出血并发症。轶事证据表明磺达肝癸钠治疗自身免疫性HIT有失败的风险，并支持使用利伐沙班治疗HIT，证明更大规模的研究是合理的。
Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin that is associated with life-threatening thrombotic complications. More rarely, HIT may begin after stopping of heparin or after flushes of heparin (autoimmune HIT). Fondaparinux has been proposed as a candidate treatment for HIT, but there are few data on its use in autoimmune HIT. An 86-year-old man with a history of diabetes mellitus, arterial hypertension, and hypercholesterolemia was admitted to our hospital for carotid endarterectomy. During surgery, only one heparin dose of 5,000 U was used. Platelet count started to decrease on the 11th day after surgery. Since the patient was not receiving heparin treatment/prophylaxis, HIT was not suspected. On day 19, platelet count was 61 × 10 3 /μL, and the patient was investigated for a diagnosis of HIT. Immunoglobulin (Ig)-G-specific enzyme-linked immunosorbent assay (ELISA) was positive and HIT was confirmed by a platelet aggregation test; fondaparinux 5 mg once a day was started. During fondaparinux treatment, platelet count did not increase and a lower leg deep vein thrombosis occurred. Fondaparinux was stopped and rivaroxaban 15 mg twice a day was started. Platelet count returned to base line after 10 days from fondaparinux withdrawal. There was no thrombotic event or bleeding complication during rivaroxaban treatment. Anecdotal evidence suggests risk of failure of fondaparinux treatment for autoimmune HIT and supports the use of rivaroxaban for treatment of HIT, justifying larger studies.