Гепарин-индуцированная тромбоцитопения: лабораторная диагностика, лечение, профилактика

Гепарин-индуцированная тромбоцитопения (ГИТ) — протромботическое заболевание, вызванное антителами к комплексам тромбоцитарного фактора 4 (PF4) и гепарина. ГИТ — это потенциально опасное для жизни клиническое состояние, которое необходимо подозревать у пациентов с тромбозами с тромбоцитопенией на фоне применения любых форм гепарина более 4 суток. В случае установленного диагноза ГИТ необходимо помнить об опасности дальнейшего применения любых форм гепарина. Для диагностики ГИТ необходимо использовать международные критерии «4Тs», которые позволяют своевременно предсказать высокую вероятность данного заболевания. Диагноз ГИТ требует верификации с помощью специальных лабораторных тестов. Иммуноферментный анализ и функциональные анализы крови с оценкой активности тромбоцитов на фоне гепарина позволяют верифицировать диагноз ГИТ. Наш опыт внедрения ИФА для диагностики ГИТ показал высокую стоимость проведения данного анализа при относительно низкой частоте встречаемости ГИТ в условиях одной больницы. Следовательно, требуется создание региональных лабораторных хабов, которые необходимы в масштабах крупного города. Негепариновые антикоагулянты, которые ингибируют образование тромбина, включая прямые пероральные антикоагулянты, составляют основу лечения тромботических осложнений ГИТ. При ГИТ нежелательно применение варфарина как альтернативного антикоагулянта до полного восстановления количества тромбоцитов. Проведен обзор литературы в медицинских ресурсах e-Library, Pubmed, Web of Science, Scopus, посвященных вопросам диагностики, лечения и профилактики с использованием ключевых слов.

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