A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine

doi:10.12114/j.issn.1007-9572.2022.0531

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (06): 769-774.DOI: 10.12114/j.issn.1007-9572.2022.0531

• Research of Typical Cases • Previous Articles

A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine

1. The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
2. Department of Peripheral Vascular Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China

Received:2022-06-08 Revised:2022-08-06 Published:2023-02-20 Online:2022-08-25
Contact: ZHANG Yue
About author:
GONG R, ZHANG Y, CHENG Z X, et al. A case report of venous thromboembolism with heparin-induced thrombocytopenia characterized by venous limb gangrene treated with Integrated Traditional Chinese and Western Medicine[J]. Chinese General Practice, 2023, 26 (6) : 769-774.

以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道

1．250014　山东省济南市，山东中医药大学第一临床医学院
2．250014　山东省济南市，山东中医药大学附属医院周围血管病科

通讯作者: 张玥
作者简介:
公瑞，张玥，程志新，等.以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道[J].中国全科医学，2023，26（6）：769-774.[www.chinagp.net] 作者贡献：公瑞负责论文的起草及撰写；张玥负责最终版本修订，对论文负责；程志新负责临床数据收集及整理；唐卫荷负责文献搜集及图表绘制。
基金资助:
国家自然科学基金资助项目(81774311)

Abstract

Abstract:

Heparin-induced thrombocytopenia (HIT) and venous limb gangrene (VLG) are rare complications of venous thromboembolism (VTE), with high rates of mortality and morbidity once they occur. A case of VTE with HIT characterized by VLG is reported. Relatively satisfactory therapeutic effect has been achieved under the treatment of Integrated Traditional Chinese and Western Medicine, and we hope to provide a reference for clinicians to treat such diseases.

Key words: Venous thromboembolism, Heparin-induced thrombocytopenia, Venous limb gangrene, Integrated Chinese Traditional and Western Medicine therapy, Case report

摘要：

肝素诱导性血小板减少症（HIT）和静脉肢体坏疽（VLG）是静脉血栓栓塞症（VTE）的罕见并发症，致死率、致残率较高。现报告1例以VLG为特点的VTE并发HIT的病例，在中西医结合治疗下取得了较为满意的治疗效果，以期为临床医师治疗此类疾病提供参考。

关键词: 静脉血栓栓塞症, 肝素诱导性血小板减少症, 静脉肢体坏疽, 中西医结合疗法, 病例报告

GONG Rui,ZHANG Yue,CHENG Zhixin, et al. A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine[J]. Chinese General Practice, 2023, 26(06): 769-774. DOI: 10.12114/j.issn.1007-9572.2022.0531.
公瑞,张玥,程志新等. 以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道[J]. 中国全科医学, 2023, 26(06): 769-774. DOI: 10.12114/j.issn.1007-9572.2022.0531.

Figures/Tables 8

Figuer 1 Images of lower limbs at initial admission on February 14，2021

Figure 2 Images of lower limbs of patient on March 4，2021

Table 1 Limb circumference （cm） at different positions of lower limbs before treatment and 24 d after treatment

时间	髌骨上缘上15 cm		髌骨下缘下15 cm		内踝尖上10 cm
时间	左下肢	右下肢	左下肢	右下肢	左下肢	右下肢
治疗前	52.5	64.0	40.5	43.0	31.0	32.0
治疗后24 d	52.0	55.0	33.0	32.5	22.0	22.5

Figure 3 Bipedal image of patient at the second admission on May 5，2021

Figure 4 Patient Bipedal debridement images on May 13，2021

Figure 5 Bipedal image of patient at the 3rd admission on August 15，2021

Figure 6 Patient images of removing bipedal negative pressure on August 28，2021

Figure 7 Patient one year follow-up images of Bipedal on March 20，2019

References 34

[1]	ATHANASOULIS C A, KAUFMAN J A, HALPERN E F，et al. Inferior vena caval filters：review of a 26-year single-center clinical experience[J]. Radiology，2000，216(1):54-66. DOI：10.1148/radiology.216.1.r00jl1254.
[2]	段鹏飞，李晓强，吴浩荣，等.手术联合介入治疗急性下肢深静脉血栓[J].中华外科杂志，2009，47(19):1512-1513. DOI：10.3760/cma.j.issn.0529-5815.2009.19.021.
[3]	高杰，孙赫，付晨菲，等. 下肢深静脉血栓形成中西医研究进展[J]. 中国老年学杂志，2017，37(11):2850-2853. DOI：10.3969/j.issn.1005-9202.2017.11.109.
[4]	YAN B P, KIERNAN T J, GUPTA V，et al. Combined pharmacomechanical thrombectomy for acute inferior vena cava filter thrombosis[J]. Cardiovasc Revasc Med，2008，9(1):36-40. DOI：10.1016/j.carrev.2007.09.004.
[5]	COMEROTA A J. Deep venous thrombosis and postthrombotic syndrome：invasive management[J]. Phlebology，2015，30(1 Suppl):59-66. DOI：10.1177/0268355514568846.
[6]	安鹏，尹家保，杨浩，等. 床旁彩色多普勒超声引导腘静脉置管溶栓疗法在下肢深静脉血栓治疗中的应用[J]. 中国介入影像与治疗学，2018，15(3):144-147. DOI：10.13929/j.1672-8475.201705020.
[7]	WATSON L, BRODERICK C, ARMON M P. Thrombolysis for acute deep vein thrombosis[J]. Cochrane Database Syst Rev，2014，83(1):CD002783. DOI：10.1002/14651858.CD002783.pub3.
[8]	CAKIR V, GULCU A, AKAY E，et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis：1-year follow-up results of a randomised，clinical trial[J]. Cardiovasc Intervent Radiol，2014，37(4):969-976. DOI：10.1007/s00270-014-0925-y.
[9]	KARTHIKESALINGAM A, YOUNG E L, HINCHLIFFE R J，et al. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis[J]. Eur J Vasc Endovasc Surg，2011，41(4):554-565. DOI：10.1016/j.ejvs.2011.01.010.
[10]	BEHRAVESH S, HOANG P, NANDA A，et al. Pathogenesis of thromboembolism and endovascular management[J]. Thrombosis，2017，2017:3039713. DOI：10.1155/2017/3039713.
[11]	STANLEY G A, MURPHY E H, PLUMMER M M，et al. Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis[J]. J Vasc Surg Venous Lymphat Disord，2013，1(1):52-58. DOI：10.1016/j.jvsv.2012.04.002.
[12]	赵辉，胡红耀，饶珉，等. 经皮机械性血栓清除术治疗急性髂股静脉血栓[J]. 中国介入影像与治疗学，2020，17(7):393-397. DOI：10.13929/j.issn.1672-8475.2020.07.003.
[13]	PÁRAMO J A, LOZANO M L, GONZÁLEZ-PORRAS J R，et al. Current status of diagnosis and treatment of heparin-induced thrombocytopenia （HIT）[J]. Med Clin（Barc），2022，158(2):82-89. DOI：10.1016/j.medcli.2021.05.020.
[14]	WARKENTIN T E, ROBERTS R S, HIRSH J，et al. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients[J]. Arch Intern Med，2003，163(20):2518-2524. DOI：10.1001/archinte.163.20.2518.
[15]	MARTEL N, LEE J, WELLS P S. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis：a meta-analysis[J]. Blood，2005，106(8):2710-2715. DOI：10.1182/blood-2005-04-1546.
[16]	LINKINS L A, BATES S M, LEE A Y Y，et al. Combination of 4Ts score and PF4/H-PaGIA for diagnosis and management of heparin-induced thrombocytopenia：prospective cohort study[J]. Blood，2015，126(5):597-603. DOI：10.1182/blood-2014-12-618165.
[17]	CUKER A, AREPALLY G M, CHONG B H，et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism：heparin-induced thrombocytopenia[J]. Blood Adv，2022，2(22):3360-3392. DOI：10.1182/bloodadvances.2018024489.
[18]	NG H J, THAN H, TEO E C Y. First experiences with the use of rivaroxaban in the treatment of heparin-induced thrombocytopenia[J]. Thromb Res，2015，135(1):205-207. DOI：10.1016/j.thromres.2014.06.005.
[19]	LINKINS L A, WARKENTIN T E. Rivaroxaban for treatment of HIT：a riveting first experience[J]. Thromb Res，2015，135(1):1-2. DOI：10.1016/j.thromres.2014.10.019.
[20]	HANTSON P, LAMBERT C, HERMANS C. Rivaroxaban for arterial thrombosis related to heparin-induced thrombocytopenia[J]. Blood Coagul Fibrinolysis，2015，26(2):205-206. DOI：10.1097/MBC.0000000000000205.
[21]	蒋京军，张小明，李伟，等. 利伐沙班治疗肝素诱导的血小板减少症[J]. 中华普通外科杂志（电子版），2017，32(2):160-163. DOI：10.3760/cma.j.issn.1007-631X.2017.02.019.
[22]	HAIMOVICI H. Gangrene of the extremities of venous origin；review of the literature with case reports[J]. Circulation，1950，1(2):225-240. DOI：10.1161/01.cir.1.2.225.
[23]	GRIM HOSTETLER S, SOPKOVICH J, DEAN S，et al. Warfarin-induced venous limb gangrene[J]. J Clin Aesthet Dermatol，2012，5(11):38-42.
[24]	WARKENTIN T E. Heparin-induced thrombocytopenia-associated thrombosis：from arterial to venous to venous limb gangrene[J]. J Thromb Haemost，2018，16(11):2128-2132. DOI：10.1111/jth.14264.
[25]	WARKENTIN T E, GREINACHER A, KOSTER A，et al. Treatment and prevention of heparin-induced thrombocytopenia：American college of chest physicians evidence-based clinical practice guidelines（8th edition）[J]. Chest，2008，133(6 Suppl):340S-380S. DOI：10.1378/chest.08-0677.
[26]	TAN J H, MOHAMAD Y, TAN C L H，et al. Concurrence of symmetrical peripheral gangrene and venous limb gangrene following polytrauma：a case report[J]. J Med Case Rep，2018，12(1):131. DOI：10.1186/s13256-018-1684-1.
[27]	LAOHAPENSANG K, HANPIPAT S, AWORN S，et al. Surgical venous thrombectomy for phlegmasia cerulea dolens and venous gangrene of the lower extremities[J]. J Med Assoc Thai，2013，96(11):1463-1469.
[28]	张玥. 深静脉血栓形成"瘀热互结"病机浅析[J]. 中医杂志，2009，50(11):1049-1050. DOI：10.13288/j.11-2166/r.2009.11.031.
[29]	王冰，关徐涛，王涛，等. 免疫性血小板减少症治疗体会[J]. 中医杂志，2016，57(18):1608-1610. DOI：10.13288/j.11-2166/r.2016.18.018.
[30]	贾恒，李肆柱，张溪，等. 扶正益气生血方治疗结直肠肿瘤化疗所致血小板减少症的临床效果[J]. 临床医学研究与实践，2020，5(36):142-144. DOI：10.19347/j.cnki.2096-1413.202036054.
[31]	赵敏，任德祥，夏小军. 中医药治疗原发免疫性血小板减少症1例[J]. 甘肃医药，2021，40(11):1051-1052. DOI：10.15975/j.cnki.gsyy.2021.11.036.
[32]	张晶，罗昌国，王济国，等. 升板汤治疗化疗所致血小板减少症的临床研究[J]. 辽宁中医杂志，2021，48(12):133-136. DOI：10.13192/j.issn.1000-1719.2021.12.038.
[33]	宋玮，艾儒棣，肖敏，等. 中医外科名家艾儒棣运用"通法"辨治脱疽经验[J]. 时珍国医国药，2021，32(10):2519-2521.
[34]	MOU Y, WANG X Z, WANG T，et al. Clinical application and pharmacological mechanism of Wuling Powder in the treatment of ascites：a systematic review and network pharmacological analysis[J]. Biomedecine Pharmacother，2022，146:112506. DOI：10.1016/j.biopha.2021.112506.

A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine

以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道

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