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Phlebologie 1998; 27(04): 111-116
DOI: 10.1055/s-0037-1616965
Übersichtsarbeit
Schattauer GmbH

Die Heparin-induzierte Thrombozytopenie

R. Pihusch
1   Aus der Medizinischen Klinik III der Ludwig-Maximilians-Universität, Klinikum Großhadern (Direktor: Prof. Dr. med. Dr. h. c. Wolfgang Wilmanns)
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Publication History

Publication Date:
29 December 2017 (online)

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Zusammenfassung

Die Heparin-induzierte Thrombozytopenie (HIT) ist eine häufige Komplikation nach Heparingabe. Während die HIT Typ 1 eine harmlose pharmakologische Begleiterscheinung ist, bedroht die HIT Typ 2 den Patienten vital durch eine paradoxe Thromboembolieneigung und arterielle Gefäßverschlüsse. Der Typ 2 beruht auf einer immunologischen Reaktion gegen einen Komplex aus Heparin und Plättchenfaktor-4 (PF4)-Aggregaten. Die dabei entstehenden IgG-Antikörper aktivieren per Fc-Rezeptor die Thrombozyten, schädigen Endothelzellen und lassen hochthrombogene Mikropartikel entstehen. Patienten mit HIT Typ 2 haben daher ein massiv erhöhtes Thromboembolierisiko und neigen zudem zu arteriellen Gefäßverschlüssen mit entsprechend deletäten Folgen. Die Therapie besteht in einer sofortigen Heparinkarenz und Fortsetzung der Antikoagulation mit Hirudin oder Heparinoiden.

Summary

Heparin-induced thrombocytopenia (HIT) is a relatively common disorder induced by therapeutic or prophylactic administration of heparin. HIT type 1 is an insignificant pharmacologic epiphenomenon of heparin therapy. However, HIT type 2 leads to live-threatening thromboembolic complications and arterial occlusions. It is caused by an immunologic reaction to a complex of platelet factor 4 (PF4) and heparin. The induced IgG-antibodies activate platelets via the Fc-receptor, affect the endothelium and produce highly thrombogenic microparticles. Patients with HIT type 2 have a massive increased thromboembolic risk and tend toward arterial occlusions with deletary consequences. Therapy includes stopping heparin and further anticoagulation with hirudin or heparinoids.

Résumé

La thrombopénie induite par l’héparine (TIH) est une complication suite à l’administration d’héparine. Alors que la TIH de type 1 est une manifestation pharmacologique associée bénigne, la TIH de type 2 menace le pronostic vital du patient par une tendance paradoxale à faire une thromboembolle et par des occlusion artérielles. Le type 2 response sur une réaction immunologique à un complexe d’héparine et d’héparine et d’agrégats du facteur plaquettaire 4 (FP4). Les anticorps IgG en résultant activent les thrombocytes par le récepteur Fc, endommagent les cellules endothéliales et produisent des microparticules hautement thrombogènes. Les patients atteints d’une TIH de type 2 présentent par conséquent un risque extrémement élevé de faire une thromboembolie et ont an outre tendance à étre atteints d’occlusions artérielles et leurs conséquences délétères. La thérapie consiste en l’arrêt de l’administration d’héparine et en poursuivant le traitement anticoagulant par de l’hirudine ou des héparinoides.

Schlüsselwörter

Heparin-induzierte Thrombozytopenie - Pathogenese - Therapie

Keywords

Heparin-induced thrombocytopenia - pathogenesis - therapy

Mots clés

Thrombopénie indulte par l’héparine - pathogenése - thérapie
 

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