在患有心脏性冲击的患者中,肝素诱导的血小板缩
Enzo Lüsebrink1,2, Hugo Lanz1,2, Leonhard Binzenhöfer1,2
1Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
Critical care explorations
|July 23, 2024
概括
肝素诱导的血小板缺血 (HIT) 是心脏性休克 (CS) 患者的罕见并发症,影响2.0%的病例. 在幸存者中,HIT并没有增加死亡率或恶化神经学结果,这表明目前的诊断测试可能需要改进.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 密集护理医学 密集护理医学
背景情况:
- 心脏性休克 (CS) 的死亡率很高.
- 肝素治疗在CS患者中很常见,增加了肝素诱导的血小板缩 (HIT) 的风险.
- HIT是一种严重的并发症,涉及血小板减少和高凝血能力,在重症监护中研究有限.
研究的目的:
- 确定心脏性休克患者中HIT的患病率.
- 评估HIT诊断测试的性能.
- 比较证实有和没有HIT的CS患者之间的结果.
主要方法:
- 成年CS患者怀疑HIT的回顾性双中心研究 (2010-2022年).
- 包括路德维希-马克西米利安大学医院和波恩大学医院心脏病重症监护室的患者.
- 评估了基线特征,死亡率和神经学/安全结果.
主要成果:
- HIT患病率为2.0% (57/2808名患者);查抗体在5.7%的患者中呈阳性.
- 查抗体的积极预测值为35.8%.
- 在被排除和确认的HIT组之间,在住院,1个月或12个月死亡率上没有显著差异. 神经学结果也相似.
结论:
- 在接受未分离肝素治疗的CS患者中,HIT是一种罕见的并发症.
- 在幸存者中,HIT与增加的死亡率或更糟糕的神经结果无关.
- 为了准确,标准化和具有成本效益的HIT诊断策略,需要进一步的研究.
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