IABP辅助冠脉搭桥术后肝素抗凝治疗引起HIT一例

A Case of HIT Caused by Heparin Anticoagulant Therapy after IABP Assisted Coronary Artery Bypass Grafting

摘要: 目的：提高对肝素诱导的血小板减少症(Heparin-induced thrombocytopenia, HIT)的识别与重视，减少误诊。方法：对1例肝素类药物诱导HIT患者临床资料进行回顾性分析，复习相关文献。结果：患者因急性冠脉综合症行主动脉内球囊反搏(Intra-aortic balloon pump, IABP)辅助冠脉搭桥术(Coronary artery bypass grafting, CABG)，围术期应用肝素类药物抗凝治疗后出现血小板急剧减少并有血栓形成，根据4Ts评分高度怀疑为II型HIT，停用一切肝素类药物，采用新型口服抗凝药物利伐沙班替代抗凝治疗。结论：CABG术后患者有发生桥血管血栓形成风险，同时HIT也会导致血管内血栓形成，二者大大增加了血栓形成风险，对CABG术后使用肝素类药物出现血小板减少患者需高度警惕HIT，以免发生不良事件。

Abstract: Objective: To improve the timely recognition and attention of Heparin-induced Thrombocytopenia (HIT) and reduce misdiagnosis. Methods: The clinical data of a patient with one heparin-induced HIT was analyzed retrospectively, and refer to the relevant literature for analysis. Results: The patient with Acute Coronary Syndrome (ACS) was treated with Intra-aortic Balloon Pump (IABP) assisted Coronary Artery Bypass Grafting (CABG). According to the 4Ts score highly suspected to be type II HIT, all heparin drugs were stopped and a new oral anticoagulant rivaroxaban was used instead of anticoagulant therapy. Conclusion: CABG postoperative patients have the risk of bridge thrombosis, and HIT can also lead to intravascular thrombosis. The coexistence of the two greatly increases the risk of thrombosis. Therefore, patients with thrombocytopenia after CABG use of heparin drugs should be highly vigilant HIT, so as to avoid adverse events.