Temporal aspects of heparin-induced thrombocytopenia
Temporal aspects of heparin-induced thrombocytopenia
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DOI：
10.1056/nejm200104263441704
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发表时间：
2001-04-26
影响因子：
158.5
通讯作者：
Kelton, JG
中科院分区：
文献类型：
--
作者：
Warkentin, TE;Kelton, JG
背景：肝素诱导的血小板减少症是一种相对常见的抗体介导的药物反应。我们研究了先前或当前的肝素治疗与肝素诱导的血小板减少症发作之间的时间关系。方法：我们检查了 243 名血清学证实的肝素诱导的血小板减少症患者开始肝素治疗和血小板减少症发作之间的时间。我们还通过进行血小板血清素释放测定和抗血小板因子 4 抗体测定来研究循环肝素依赖性抗体的持续性。还检查了 7 名先前发生过肝素诱导的血小板减少症并随后再次接受肝素治疗的患者的结果。结果：在 243 名患者中，有 170 名患者在开始肝素治疗后 4 天或更长时间出现血小板计数下降（70%）；在这些患者中，既往肝素治疗史并不影响血小板减少症的发作时间。其余 73 名患者 (30%) 血小板减少症发作较快（中位发作时间为开始给予肝素后 10.5 小时）；所有这些患者在过去 100 天内都接受过肝素治疗。在从血小板减少症恢复期间，血清中的肝素依赖性抗体在中位 50 至 85 天的时间内降至不可检测的水平，具体取决于所进行的测定。肝素依赖性抗体消失后再次给予肝素的7例患者中，未出现新一轮肝素诱导的血小板减少症。结论：在过去100天内接受过肝素治疗的患者，肝素诱导的血小板减少症可迅速发生。随后使用肝素时，肝素依赖性抗体不会总是再次出现。 （N Engl J Med 2001；344：1286-92。）版权所有 (C) 2001 马萨诸塞州医学会。
Background: Heparin-induced thrombocytopenia is a relatively common antibody-mediated drug reaction. We studied the temporal relation between previous or current heparin therapy and the onset of heparin-induced thrombocytopenia.Methods: We examined the time between the start of heparin therapy and the onset of thrombocytopenia in 243 patients with serologically confirmed heparin-induced thrombocytopenia. We also investigated the persistence of circulating heparin-dependent antibodies by performing a platelet serotonin-release assay and an assay for antibodies against platelet factor 4. The outcome in seven patients who had previously had an episode of heparin-induced thrombocytopenia and were later treated again with heparin was also examined.Results: A fall in the platelet count beginning four or more days after the start of heparin therapy occurred in 170 of the 243 patients (70 percent); in these patients, a history of previous heparin treatment did not influence the timing of the onset of thrombocytopenia. In the remaining 73 patients (30 percent), the onset of thrombocytopenia was rapid (median time of onset, 10.5 hours after the start of heparin administration); all these patients had been treated with heparin within the previous 100 days. During recovery from thrombocytopenia, heparin-dependent antibodies in the serum fell to undetectable levels at a median of 50 to 85 days, depending on the assay performed. In the seven patients who were given heparin again after the disappearance of heparin-dependent antibodies, a new episode of heparin-induced thrombocytopenia did not occur.Conclusions: Heparin-induced thrombocytopenia can begin rapidly in patients who have received heparin within the previous 100 days. Heparin-dependent antibodies do not invariably reappear with subsequent heparin use. (N Engl J Med 2001;344:1286-92.) Copyright (C) 2001 Massachusetts Medical Society.