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例1为24岁男性患者,因急性心肌梗死,给予阿司匹林300mg、氯吡格雷300mg口服和普通肝素10000U静脉推注,并行冠状动脉造影、经皮冠状动脉腔内成形术及支架植入术。患者术前血小板计数为228.0×10~9/L,术后1h降至36.2×10~9/L。考虑为肝素诱导的血小板减少,遂停用肝素,给予阿加曲班0.5～2μg·kg~(-1)·min~(-1)静脉滴注。第3天患者血小板升至101×10~9/L,第4天恢复正常。例2为69岁男性冠状动脉粥样硬化性心脏病患者,在冠状动脉造影术中静脉推注普通肝素3000U。之后,行冠状动脉搭桥术,术前连续7d给予低分子肝素(1mg·kg~(-1)·12h~(-1))皮下注射,术中给予普通肝素7000U静脉滴注。术前患者血小板计数197.0×10~9/L,术后降至19.2×10~9/L。停用肝素,给予阿加曲班0.5～1.5μg·kg~(-1)·min~(-1)静脉滴注,血小板计数升至146.0×10~9/L。
Example 1 A 24-year-old male patient was given aspirin 300 mg, clopidogrel 300 mg orally and unfractionated heparin 10000 U intravenously for acute myocardial infarction. Parallel coronary angiography, percutaneous transluminal coronary angioplasty and stent implantation were performed. The preoperative platelet count was 228.0 × 10 ~ 9 / L and decreased to 36.2 × 10 ~ 9 / L at 1 hour after operation. Considering heparin-induced thrombocytopenia, heparin was discontinued and 0.5 to 2 μg · kg -1 (-1) min -1 intravenous infusion of argatroban was given. On the third day, the platelet count increased to 101 × 10 ~ 9 / L and returned to normal on the fourth day. Example 2 A 69-year-old male with coronary atherosclerotic heart disease, coronary angiography intravenous injection of unfractionated heparin 3000U. Subsequent to coronary artery bypass grafting, low molecular weight heparin (1 mg · kg -1 · 12 h -1) was given subcutaneously for 7 days before operation. Intravenous heparin 7000U was administered intravenously. Preoperative platelet count 197.0 × 10 ~ 9 / L, postoperative decreased to 19.2 × 10 ~ 9 / L. Heparin was withdrawn and 0.5 ~ 1.5μg · kg -1 (-1) min -1 intravenous infusion of argatroban was given. The platelet count increased to 146.0 × 10 ~ 9 / L.