How I treat heparin-induced thrombocytopenia
How I treat heparin-induced thrombocytopenia
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DOI：
10.1182/blood-2011-11-376293
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发表时间：
2012-03-08
期刊：
影响因子：
20.3
通讯作者：
Cines, Douglas B.
中科院分区：
文献类型：
--
作者：
Cuker, Adam;Cines, Douglas B.
肝素诱导的血小板减少症是一种血栓前药物不良反应，由抗血小板因子4和肝素多分子复合物的血小板活化抗体诱导。诊断依赖于疾病概率的临床评估和实验室检测。管理包括立即停用肝素和开始替代抗凝剂。由于肝素化患者中血小板减少症的发生频率，广泛使用的免疫测定的特异性有限，更特异的功能测定的可用性有限，以及临床医生担心错过真实疾病的病例，过度检测，过度诊断和过度治疗已经变得普遍。因此，大量血小板减少症患者不必要地暴露于昂贵的替代抗凝剂及其伴随的出血风险。在这篇综述中，我们不仅描述了我们对肝素诱导的血小板减少症患者的评估和管理方法，而且还描述了我们用于最大限度地减少误诊和不必要的治疗的措施。此外，我们建议调查领域，以改善这种潜在的致命疾病的诊断和管理。（血。2012;119（10）：2209-2218）
Heparin-induced thrombocytopenia is a prothrombotic adverse drug effect induced by platelet-activating antibodies against multimolecular complexes of platelet factor 4 and heparin. Diagnosis rests on a clinical assessment of disease probability and laboratory testing. Management involves immediate discontinuation of heparin and initiation of an alternative anticoagulant. Because of the frequency of thrombocytopenia among heparinized patients, the limited specificity of widely available immunoassays, the limited availability of more specific functional assays, and clinicians' fears of missing a case of true disease, overtesting, overdiagnosis, and overtreatment have become common. As a result, a substantial number of thrombocytopenic patients are unnecessarily exposed to costly alternative anticoagulants and their attendant risk of bleeding. In this review, we describe not only our approach to the evaluation and management of patients with heparin-induced thrombocytopenia, but also the measures we use to minimize misdiagnosis and unnecessary treatment of patients without the disease. In addition, we propose areas of investigation for improvement of the diagnosis and management of this potentially fatal disorder. (Blood. 2012;119(10):2209-2218)