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Blóðflögufæð og segamyndun vegna heparíns : yfirlitsgrein

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Authors
Páll Torfi Önundarson
Issue Date
1991-09-01

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Citation
Læknablaðið 1991, 77(7):277-84
Abstract
There are two types of heparin-induced thrombocytopenia (HIT). The mild type I HIT is of no clinical consequence and is caused by a direct heparin induced primary wave platelet aggregation. On the other hand type II HIT can be severe and associated with thrombotic complications as well as significant mortality. Current evidence suggests that type II HIT is caused by the formation of heparin-IgG immunecomplexes on the surface of platelets and endothelial cells. The immunecomplexes cause platelet granule release reaction, irreversible platelet aggregation and possibly tissue factor expression on endothelial cells. Consequently thrombocytopenia and sometimes thrombosis occurs. The uncomplicated type II thrombocytopenia is self-limited and resolves on discontinuation of heparin, but primary and secondary prevention as well as treatment of new thrombosis remains a challenge for clinicians. Therapeutic options include antiplatelet agents, old and new antithrombotic agents and thrombolytic therapy.
Tvær gerðir eru af blóðflögufæð vegna heparins (BVH). Væg og einkennalaus lækkun á blóðflögum verður í nálega 5% sjúklinga á heparínblóðþynningu, og verður hún af völdum afturkræfrar samloðunar blóðflaga vegna beinnar verkunar heparins (1. gerð BVH). Hálft-1% sjúklinga fá hinsvegar svæsnari BVH og getur hún valdið blóðsegamyndun, drepi og dauða (2. gerð). Rannsóknir benda til þess að 2. gerð BVH verði vegna myndunar heparín-IgG ónæmisflækja á frumuhimnum blóðflaga og æðaþelsfrumna. Afleiðing þess er óafturkræf samloðun blóðflaga og ef til vill myndun og virkjun vefjaþáttar á yfirborði æðaþelsfrumna. Af því leiðir blóðflögufæð og segamyndun í sumum tilfellum. Blóðflögufæðin lagast sjálfkrafa við stöðvun heparíngjafar, en læknum er vandi á höndum hvað varðar áframhaldandi blóðþynningu, síðari endurgjöf hraðvirkrar blóðþynningar og meðferð nýrra sega af völdum mótefna gegn heparíni. Faraldsfræði, einkenni, meingerð, greining og helstu meðferðarmöguleikar 2. gerðar BVH eru rakin í þessari yfirlitsgrein.
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