Tom 12, Nr 4 (2017)
Artykuł przeglądowy
Opublikowany online: 2017-09-19
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Małopłytkowość indukowana protaminą — nowy problem czy inny typ małopłytkowości poheparynowej?
DOI: 10.5603/FC.2017.0068
Folia Cardiologica 2017;12(4):355-361.
Streszczenie
Protamina jest powszechnie stosowanym środkiem odwracającym antykoagulacyjne działanie heparyny niefrakcjonowanej, szczególnie po zabiegach kardiochirurgicznych. Najnowsze badania wskazują, że część pacjentów poddanych zabiegowi krążenia pozaustrojowego jest narażona na trombocytopenię w trakcie ekspozycji na heparynę. Wielkocząsteczkowe kompleksy protaminy i heparyny wywołują immunizację i produkcję immunoglobulin G, które aktywują płytki krwi za pośrednictwem receptora FcγIIa. Podczas krążenia pozaustrojowego infuzja protaminy u niektórych pacjentów zwiększa ryzyko wczesnych powikłań zakrzepowych, spowodowanych obecnością tych przeciwciał we krwi. W niniejszym przeglądzie skupiono się na pracach, w których przebadano mechanizm aktywacji płytek krwi przez anty-protaminowo-heparynowe przeciwciała. Porównano je z przeciwciałami wywołującymi immunologiczną małopłytkowość poheparynową. Ponadto opisano kliniczne konsekwencje trombocytopenii indukowanej protaminą, czynniki ryzyka i ogólne wytyczne dotyczące terapii powikłań zakrzepowo-zatorowych u pacjentów kardiochirurgicznych.
Słowa kluczowe: protaminaheparynatrombocytopenia
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