vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2018-1-114-119vtio-862Research ArticleКлинические наблюденияClinical CasesГЕПАРИН-ИНДУЦИРОВАННАЯ ТРОМБОЦИТОПЕНИЯ У ПАЦИЕНТА ПОСЛЕ ТРАНСПЛАНТАЦИИ ПЕЧЕНИHEPARIN-INDUCED THROMBOCYTOPENIA IN PATIENT POST LIVER TRANSPLANTATIONХубутияМ. Ш.HubutijaM. Sh.ЖуравельС. В.Zhuravel’S. V.КузнецоваН. К.KuznetsovaN. K.

Кузнецова Наталия Константиновна

129090, Москва, Большая Сухаревская площадь, д. 3, к. 5

Kuznetsova Natalia Konstantinovna

3/5 Bol’shaya Sukharevskaya sq. Moscow, 129090

natalikuz@inbox.ruКлычниковаЕ. В.KlychnikovaЕ. V.ДоноваЛ. В.DonovaL. V.Государственное бюджетное учреждение здравоохранения города Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения города Москвы»РоссияSklifosovsky Research Institute for Emergency Medicine Health Department of MoscowRussian Federation201824042018201114119Copyright © Хубутия М.Ш., Журавель С.В., Кузнецова Н.К., Клычникова Е.В., Донова Л.В., 20182018Хубутия М.Ш., Журавель С.В., Кузнецова Н.К., Клычникова Е.В., Донова Л.В.Hubutija M.S., Zhuravel’ S.V., Kuznetsova N.K., Klychnikova Е.V., Donova L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/862

Широкое применение гепарина в качестве антикоагулянта привело к формированию проблемы гепарининдуцированной тромбоцитопении (ГИТ). На современном этапе число различных направлений хирургической практики, в которых приходится сталкиваться с этим грозным осложнением, увеличивается. Представлен собственный опыт диагностики ГИТ у молодого пациента после трансплантации печени в НИИ скорой помощи им. Н.В. Склифосовского, который позволил вовремя установить причину массивного тромбообразования, выполнить ретрансплантацию печени, исключив использование гепарина, и сохранить жизнь пациенту.

The widespread use of heparin as an anticoagulant has led to the formation of the problem of heparin-induced thrombocytopenia (HIT). At the present time, the number of different areas of surgical practice, in which we have to face this threat complication, is increasing. We present the clinical case of HIT in a young patient after liver transplantation. Diagnostics of HIT allowed in time to establish the cause of massive thrombus formation, perform liver transplantation, exclude the use of heparin and save the life of the patient.

гепарин-индуцированная тромбоцитопениятрансплантация печениheparin-induced thrombocytopenialiver transplantationReferencesKelton JG, Warkentin TE. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008; 112 (7): 2607–2616. doi: 10.1182/blood-2008-02-078014.Kelton JG, Warkentin TE. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008; 112 (7): 2607–2616. doi: 10.1182/blood-2008-02-078014.Weismann RE, Tobin RW. Arterial embolism occurring during systemic heparin therapy. AMA Arch. Surg. 1958; 76 (2): 219–225. PMID:13497418.Weismann RE, Tobin RW. Arterial embolism occurring during systemic heparin therapy. AMA Arch. Surg. 1958; 76 (2): 219–225. PMID:13497418.Natelson EA, Lynch EC, Alfrey CPJr, Gross JB. Heparininduced thrombocytopenia. An unexpected response to treatment of consumption coagulopathy. Ann. Intern. Med. 1969; 71 (6): 1121–1125. PMID:5391254.Natelson EA, Lynch EC, Alfrey CPJr, Gross JB. Heparininduced thrombocytopenia. An unexpected response to treatment of consumption coagulopathy. Ann. Intern. Med. 1969; 71 (6): 1121–1125. PMID:5391254.Rhodes GR, Dixon RH, Silver D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg. Gynecol. Obstet. 1973; 136 (3): 409–416. PMID:4688805.Rhodes GR, Dixon RH, Silver D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg. Gynecol. Obstet. 1973; 136 (3): 409–416. PMID:4688805.Brieger DB, Mak KH, Kottke-Marchant K, Topol EJ. Heparininduced thrombocytopenia. J. Am. Coll. Cardiol. 1998; 31 (7): 1449–1459. PMID:9626819.Brieger DB, Mak KH, Kottke-Marchant K, Topol EJ. Heparininduced thrombocytopenia. J. Am. Coll. Cardiol. 1998; 31 (7): 1449–1459. PMID:9626819.Jang IK, Hursting MJ. When heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation. 2005; 111 (20): 2671–2683. doi:10.1161/CIRCULATIONAHA.104.518563.Jang IK, Hursting MJ. When heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation. 2005; 111 (20): 2671–2683. doi:10.1161/CIRCULATIONAHA.104.518563.Warkentin TE, Kelton JG. A 14-year study of hep-arininducedthrombocytopenia. Am. J. Med. 1996; 101 (5): 502–507. PMID:8948273.Warkentin TE, Kelton JG. A 14-year study of hep-arininducedthrombocytopenia. Am. J. Med. 1996; 101 (5): 502–507. PMID:8948273.Motokawa S, Torigoshi T, Maeda Y, Maeda K, Jiuchi Y, Yamaguchi T et al. IgG-class anti-PF4/heparin antibodies and symptomatic DVT in orthopedic surgery patients receiving different anti-thromboembolic prophylaxis therapeutics. BMC Musculoskelet. Disord. 2011; 12: 22. doi: 10.1186/1471-2474-12-22.Motokawa S, Torigoshi T, Maeda Y, Maeda K, Jiuchi Y, Yamaguchi T et al. IgG-class anti-PF4/heparin antibodies and symptomatic DVT in orthopedic surgery patients receiving different anti-thromboembolic prophylaxis therapeutics. BMC Musculoskelet. Disord. 2011; 12: 22. doi: 10.1186/1471-2474-12-22.Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N. Engl. J. Med. 2001; 344 (17): 1286–1292. doi:10.1056/NEJM200104263441704.Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N. Engl. J. Med. 2001; 344 (17): 1286–1292. doi:10.1056/NEJM200104263441704.Warkentin TE, Kelton JG. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann. Intern. Med. 2001; 135 (7): 502–506. PMID:11578153.Warkentin TE, Kelton JG. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann. Intern. Med. 2001; 135 (7): 502–506. PMID:11578153.Greinacher A, Pötzsch B, Amiral J, Dummel V, Eichner A, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen. Thromb. Haemost. 1994; 71 (2): 247–251. PMID:8191407.Greinacher A, Pötzsch B, Amiral J, Dummel V, Eichner A, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen. Thromb. Haemost. 1994; 71 (2): 247–251. PMID:8191407.Gosselin RC, Dager WE, King JH, Janatpour K, Mahackian K, Larkin EC et al. Effect of direct thrombin inhibitors, bivalirudin, lepirudin, and argatroban, on prothrombin time and INR values. Am. J. Clin. Pathol. 2004; 121 (4): 593–599. doi:10.1309/D79K-4YG7-8NTN-YY38.Gosselin RC, Dager WE, King JH, Janatpour K, Mahackian K, Larkin EC et al. Effect of direct thrombin inhibitors, bivalirudin, lepirudin, and argatroban, on prothrombin time and INR values. Am. J. Clin. Pathol. 2004; 121 (4): 593–599. doi:10.1309/D79K-4YG7-8NTN-YY38.Messerli AW, Askari AT, Lincoff AM. Management strategies in antithrombotic therapy. Chichester, England; Hoboken, N.J.: John Wiley, 2007: 350. doi: 10.1002/9780470518137.fmatter.Messerli AW, Askari AT, Lincoff AM. Management strategies in antithrombotic therapy. Chichester, England; Hoboken, N.J.: John Wiley, 2007: 350. doi: 10.1002/9780470518137.fmatter.Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M et al. Heparin-induced thrombocytopenia in patients treated with low-molecularweight heparin or unfractionated heparin. N. Engl. J. Med. 1995; 332 (20): 1330–1335. doi:10.1056/NEJM199505183322003.Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M et al. Heparin-induced thrombocytopenia in patients treated with low-molecularweight heparin or unfractionated heparin. N. Engl. J. Med. 1995; 332 (20): 1330–1335. doi:10.1056/NEJM199505183322003.Warkentin TE, Greinacher A. So, does low-molecularweight heparin cause less heparin-induced thrombocytopenia than unfractionated heparin or not? Chest. 2007; 132 (4): 1108–1110. doi:10.1378/chest.07-1553.Warkentin TE, Greinacher A. So, does low-molecularweight heparin cause less heparin-induced thrombocytopenia than unfractionated heparin or not? Chest. 2007; 132 (4): 1108–1110. doi:10.1378/chest.07-1553.Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N. Engl. J. Med. 2006; 355 (8): 809–817. doi:10.1056/NEJMcp052967.Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N. Engl. J. Med. 2006; 355 (8): 809–817. doi:10.1056/NEJMcp052967.Datta I, Ball CG, Rudmik L, Hameed SM, Kortbeek JB. Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature. J. Trauma Manag. Outcomes. 2010; 4: 1. doi: 10.1186/1752-2897-4-1.Datta I, Ball CG, Rudmik L, Hameed SM, Kortbeek JB. Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature. J. Trauma Manag. Outcomes. 2010; 4: 1. doi: 10.1186/1752-2897-4-1.Warkentin TE, Sheppard JA, Sigouin CS, Kohlmann T, Eichler P, Greinacher A. Gender imbalance and risk factor interaction in heparin-induced thrombocytopenia. Blood. 2006; 108 (9): 2937–2941. doi:10.1182/blood-2005-11-012450.Warkentin TE, Sheppard JA, Sigouin CS, Kohlmann T, Eichler P, Greinacher A. Gender imbalance and risk factor interaction in heparin-induced thrombocytopenia. Blood. 2006; 108 (9): 2937–2941. doi:10.1182/blood-2005-11-012450.Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br. J. Haematol. 2003; 121 (4): 535–555. PMID:12752095.Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br. J. Haematol. 2003; 121 (4): 535–555. PMID:12752095.Linkins L, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al. Treatment and prevention of heparininduced thrombocytopenia: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141 (2, Suppl.): 495–530. doi: 10.1378/chest.11-2303.Linkins L, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al. Treatment and prevention of heparininduced thrombocytopenia: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141 (2, Suppl.): 495–530. doi: 10.1378/chest.11-2303.Greinacher A, Warkentin TE. Risk of Heparin-induced thrombocytopenia in patients receiving thromboprophylaxis. Exp. Rev. Hematol. 2008; 1 (1): 75–85. doi: 10.1586/17474086.1.1.75.Greinacher A, Warkentin TE. Risk of Heparin-induced thrombocytopenia in patients receiving thromboprophylaxis. Exp. Rev. Hematol. 2008; 1 (1): 75–85. doi: 10.1586/17474086.1.1.75.Warkentin TE, Sheppard JA, Horsewood P, Simpson PJ, Moore JC, Kelton JG. Impact of the patient population on the risk for Heparin-induced thrombocytopenia. Blood. 2000; 96 (5): 1703–1708. PMID:10961867.Warkentin TE, Sheppard JA, Horsewood P, Simpson PJ, Moore JC, Kelton JG. Impact of the patient population on the risk for Heparin-induced thrombocytopenia. Blood. 2000; 96 (5): 1703–1708. PMID:10961867.Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of Heparin-induced thrombocytopenia in two clinical settings. J. Thromb. Haemost. 2006; 4 (4): 759–765. doi:10.1111/j.1538-7836.2006.01787.x.Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of Heparin-induced thrombocytopenia in two clinical settings. J. Thromb. Haemost. 2006; 4 (4): 759–765. doi:10.1111/j.1538-7836.2006.01787.x.Бокерия ЛА, Чигерин ИН. Гепарининдуцированная тромбоцитопения (современное состояние проблемы). М.: Изд. НЦССХ им. А.Н. Бакулева, 2007: 96.Bokeriya LA, Chigerin IN. Geparinindutsirovannaya trombotsitopeniya (sovremennoe sostoyanie problemy). M.: Izd. NTsSSKh im. A.N. Bakuleva, 2007: 96 [in Russ.].Fimognari FL, Violi F. Portal vein thrombosis in liver cirrhosis. Intern. Emerg. Med. 2008; 3 (3): 213–218. doi: 10.1007/s11739-008-0128-0.Fimognari FL, Violi F. Portal vein thrombosis in liver cirrhosis. Intern. Emerg. Med. 2008; 3 (3): 213–218. doi: 10.1007/s11739-008-0128-0.Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005; 54 (5): 691–697. doi:10.1136/gut.2004.042796.Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005; 54 (5): 691–697. doi:10.1136/gut.2004.042796.Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology. 1985; 89 (2): 279–286. PMID:4007419.Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology. 1985; 89 (2): 279–286. PMID:4007419.Андрейцева ОИ, Журавель СВ, Донова ЛВ, Джаграев КР, Чжао АВ. Профилактика и лечение сосудистых осложнений после трансплантации печени. Трансплантология. 2012; (1–2): 33–37.Andreytseva O.I., Zhuravel’ SV, Donova LV, Dzhagraev KR, Chzhao AV. Profi laktika i lechenie sosudistykh oslozhneniy posle transplantatsii pecheni. Transplantologiya. 2012; (1–2): 33–37 [in Russ.].Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J. Gastroenterol. 2006; 12 (13): 2115–2159. PMID:16610067.Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J. Gastroenterol. 2006; 12 (13): 2115–2159. PMID:16610067.

The authors declare that there are no conflicts of interest present.