# DVT病人使用未分餾肝素第7天,血小板由245→95千且右腿DVT進展。應預期的處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374971&lang=zh-tw  
> language: zh-TW  
> subject: Psychosocial Integrity  
> category: PSI

## 題目

DVT病人使用未分餾肝素第7天,血小板由245→95千且右腿DVT進展。應預期的處置?複選。

1

停用所有肝素包括管路沖洗與LMWH

2

輸注血小板以維持10萬以上

3

血小板超過15萬時單獨重新使用warfarin

4

送HIT抗體(PF4)ELISA與血清素釋放試驗

5

開始argatroban或bivalirudin等非肝素抗凝劑

## 解析

HIT為對heparin-PF4複合體之免疫反應,引發血栓。必須停用所有肝素(含管路沖洗與LMWH)。活動性或高風險血栓需開始非肝素抗凝劑(argatroban、bivalirudin)。確診以PF4 ELISA再SRA。輸注血小板通常禁忌,會加重血栓。Warfarin單獨開始因蛋白C耗竭引起皮膚壞死與靜脈肢端壞疽,屬禁忌 — 須在血小板回復後與非肝素藥重疊使用。

## 深入解析

4Ts評分:6-8高、4-5中、0-3低。中或高機率時結果未出前即停肝素。

## 臨床情境

4T評分:時間2、血小板減少2、血栓2、其他原因不太可能1 = 7(HIT高機率)。

## 重要概念

- **HIT II型** — 免疫介導性肝素誘發血小板減少 — 合併血栓風險。
- **Argatroban** — 直接凝血酶抑制劑 — HIT之非肝素抗凝劑。
- **4Ts評分** — HIT前驗概率評分 — 血小板減少、時間、血栓、其他原因。

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