Nonheparin Anticoagulants for Heparin-Induced Thrombocytopenia
Nonheparin Anticoagulants for Heparin-Induced Thrombocytopenia
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DOI：
10.1056/nejmct1206642
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发表时间：
2013-02-21
影响因子：
158.5
通讯作者：
Bates, Shannon M.
中科院分区：
文献类型：
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作者：
Kelton, John G.;Arnold, Donald M.;Bates, Shannon M.
一名57岁的男子7天前因膝盖置换手术并发症仍在医院接受治疗。术后第一天开始低分子量肝素预防。在第7天对左腿肿胀进行压迫超声检查，发现近端深静脉血栓形成。全血细胞计数显示，他的血小板计数已从每升300 × 10（9）降至每升125 × 10（9），肝素诱导的血小板减少症的酶免疫测定显示血小板因子4（PF 4）-肝素复合物的抗体滴度较高。患者肾功能正常。重症监护室的医生想知道最好的治疗方法。
A 57-year-old man remains in the hospital after experiencing complications from knee-replacement surgery 7 days ago. Low-molecular-weight heparin prophylaxis is initiated on the first postoperative day. Compression ultrasonography performed for left leg swelling noted on day 7 shows a proximal deep-vein thrombosis. A complete blood count reveals that his platelet count has decreased from 300x10(9) per liter to 125x10(9) per liter, and an enzyme immunoassay for heparin-induced thrombocytopenia shows a high titer of antibodies against platelet factor 4 (PF4)-heparin complexes. The patient has normal renal function. The physician in the intensive care unit wonders about the best treatment.