直接口服抗凝剂
已发表过直接口服抗凝剂(如利伐沙班、阿哌沙班、达比加群和依度沙班)用于治疗 HIT 的适应症外使用的病例报告。[46]Shatzel JJ, Crapster-Pregont M, Deloughery TG. Non-vitamin K antagonist oral anticoagulants for heparin-induced thrombocytopenia. A systematic review of 54 reported cases. Thromb Haemost. 2016 Apr 14 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/27075620?tool=bestpractice.com迄今为止最高水平的证据来自一项小型的前瞻性队列研究,该研究表明,利伐沙班对于预防确诊的 HIT 患者出现复发性血栓形成是安全有效的。[47]Linkins LA, Warkentin TE, Pai M, et al. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study. J Thromb Haemost. 2016 Apr 8 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/27061271?tool=bestpractice.com
血浆置换
对于有近期 HIT 病史、需要实行心肺体外循环手术的患者以及对标准治疗无反应的活动性 HIT 患者,建议作为一个治疗策略。迄今为止的证据均为回顾性病例报告,因此,该方法仍处于试验阶段。[48]Karafin MS, Sachais BS, Connelly-Smith L, et al. NHLBI state of the science symposium in therapeutic apheresis: knowledge gaps and research opportunities in the area of hematology-oncology. J Clin Apher. 2016;31:38-47.http://onlinelibrary.wiley.com/doi/10.1002/jca.21400/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25940408?tool=bestpractice.com