目的：探讨急性下肢深静脉血栓形成（ deep venous thrombosis，DVT）患者抗凝治疗致Ⅱ型肝素诱导血小板减少症（ heparin-induced thrombocytopenia，HIT）的诊治要点。方法回顾性分析1例急性 DVT 应用低分子肝素抗凝治疗致Ⅱ型 HIT患者临床资料，并复习相关文献。结果患者因急性 DVT 入院，下肢静脉彩色多普勒超声检查示左下肢股浅静脉至腘静脉血栓形成，给予低分子肝素5000 U 每12 h 1次皮下注射，以及对症支持治疗。治疗后1周查血小板急剧减少至8×109/L，复查下肢静脉彩色多普勒超声示双下肢静脉广泛血栓形成，4Ts 评分7分，排除其他可能致血小板减少病因，确诊为Ⅱ型 HIT。立即停用低分子肝素及含肝素的封管液，改用阿加曲班抗凝治疗，血小板逐步恢复正常，血栓得到控制。出院后为预防血栓复发，予华法林继续抗凝治疗至少3个月。结论Ⅱ型HIT病情凶险，4Ts评分结合抗体检测可协助诊断。一旦发生 HIT，应立即停用肝素类药物，同时使用治疗剂量的替代抗凝药物是治疗本病的关键。%Objective To investigate key points in diagnosis and treatment of heparin-induced thrombocytopenia (HIT)induced by the anticoagulation therapy(DVT)of lower limbs. Methods Clinical data of one acute DVT of lower limbs patient with type Ⅱ HIT induced by anticoagulation therapy of low molecular heparin was retrospectively analyzed,and relevant literature was also reviewed. Results The patient was admitted for acute DVT. Doppler ultrasound showed that thrombosis was from left lower superficial femoral vein to the popliteal vein. The patient was subcutaneously injected with 5000 U low molecular heparin by one time for every 12 h and other supportive treatments. Platelet count rapidly reduced to 8 × 109/L after treatment for 1 week,and general thrombosis of both veins of lower extremities was found by rechecking doppler ultrasound,and 4Ts score was 7. Type Ⅱ HIT was confirmed after excluding other etiological factors of thrombocyto-penia. Platelet count returned to normal levels gradually,and thrombosis was controlled after replacing the low molecular hep-arin and containing heparinic tube sealing fluid to Argatroban. Anticoagulation therapy with Warfarin continued for 3 months at least after discharge for preventing recurrence. Conclusion Type Ⅱ HIT is a very dangerous,and 4Ts scores combined with heparin dependent platelet antibody test can help the diagnosis. If HIT happens,heparin drugs should be discontinued imme-diately,and the therapeutic dose of anticoagulant drugs should be given at the same time. Those are the key points in treat-ment of type Ⅱ HIT.
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