替罗非班致重度血小板减少1例及文献分析

doi:10.19803/j.1672-8629.20210664

摘要/Abstract

摘要： 目的探讨替罗非班相关血小板减少的临床特点。方法报道1例替罗非班相关血小板减少患者的诊治经过,并对该例及检索 PubMed、Sinomed,中国知网以及万方数据（从建库至 2021年1月26 日）收集到的相关病例的主要临床资料进行汇总分析。结果收治1例急性脑梗死患者,予静脉溶栓后联合替罗非班治疗,替罗非班应用6 h发现血小板减少,停用替罗非班后4 d血小板恢复正常水平。本研究纳入分析的患者共13例,男性10例、女性3例;平均年龄（60.4±12.4）岁;急性冠脉综合征11例,急性脑梗死2例;阿替普酶溶栓后应用替罗非班者1例,单用替罗非班患者2例,联用其他抗栓药物者10例。应用替罗非班至发生血小板减少的中位时间为6.0(2.5,22.3) h;4例为重度血小板减少,9例为极重度血小板减少;13例患者均停用替罗非班,1例予血小板输注,2例静脉输注血小板同时给予丙种球蛋白治疗。暂停替罗非班后,血小板平均5(4,6) d后恢复正常。结论替罗非班相关血小板减少可发生于用药6 h内,停用替罗非班,或酌情对症治疗后,血小板可恢复正常。

关键词: 替罗非班, 血小板减少, 药物副作用, 药品不良反应

Abstract: Objective To explore the clinical characteristics of tirofiban-induced thrombocytopenia. Methods The diagnosis and treatment of a patient with thrombocytopenia induced by tirofiban were reported. The main clinical data of the case and relevant cases collected from PubMed, Sinomed, CNKI, and Wanfang database (as of 26 January, 2021) were summarized and analyzed. Results An acute ischemic stroke patient receiving thrombolysis combined with tirofiban was reported six hours after the application of tirofiban, the routine blood test showed thrombocytopenia. Tirofiban was discontinued and the platelet count returned to the normal range on the fourth day. A total of 13 patients were enrolled in the analysis, including 10 males and 3 females, with an average age of 60.4±12.4 years. There were 11 cases of acute coronary syndrome and 2 cases of acute ischemic stroke. 1 patient received intravenous recombinant tissue plasminogen activator combined with tirofiban, 2 patients were treated with tirofiban alone and 10 were treated with tirofiban combined with other antithrombotic drugs. The median time from the application of tirofiban to onset of thrombocytopenia was 6.0 (2.5, 22.3) hours. All the patients were defined as severe thrombocytopenia. After the onset of thrombocytopenia, tirofiban was discontinued in all the 13 patients. Of them, 1 case was improved with intravenous platelet transfusion, 2 cases received human immunoglobulin combined with platelet transfusion. With drug discontinuation, the platelet count returned to the normal range in about 5 days. Conclusion tirofiban‐related thrombocytopenia may occur in 6 hours after the first medication, which could be improved by drug withdrawal alone or combination with symptomatic treatments as appropriate.

Key words: tirofiban, thrombocytopenia, drug‐related side effects, adverse drug reaction

中图分类号:

R994.11
R972

王媛, 王平平, 郭桂丽, 冯英楠, 马青峰. 替罗非班致重度血小板减少1例及文献分析[J]. 中国药物警戒, 2022, 19(10): 1140-1144.

WANG Yuan, WANG Pingping, GUO Guili, FENG Yingnan, MA Qingfeng. One case of clinical and literature case analysis on tirofiban-induced thrombocytopenia[J]. Chinese Journal of Pharmacovigilance, 2022, 19(10): 1140-1144.

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