| 曹成,鲁菲菲,刘健,等.氯吡格雷致血栓性血小板减少性紫癜 1例及文献复习[J].安徽医药,2023,27(11):2327-2332. |
| 氯吡格雷致血栓性血小板减少性紫癜 1例及文献复习 |
| One case report and literature review on clopidogrel-induced thrombotic thrombocytopenic purpura |
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| DOI：10.3969/j.issn.1009-6469.2023.11.046 |
| 中文关键词: 血小板减少 血栓性血小板减少性紫癜 药物不良反应 氯吡格雷 |
| 英文关键词: Thrombocytopenia Thrombotic thrombocytopenic purpura Adverse drug reaction Clopidogrel |
| 基金项目:江苏省药学会 -天晴医院药学基金科研项目( Q202124) |
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| 中文摘要: |
| 目的了解氯吡格雷诱发血栓性血小板减少性紫癜( TTP)不良反应的临床特点。方法针对南京医科大学附属苏州医院 1例冠脉造影后使用氯吡格雷后出现神经精神症状改变、血小板下降的病例进行分析。检索万方数据、中国知网、维普、 PubMed数据库中关于氯吡格雷诱发 TTP的案例报道，结合本例病人信息，分析、讨论氯吡格雷诱发 TTP的临床表现、实验室检查以及治疗和转归。结果在数据库中共检索到病例报道类文献 11篇，共 13例病人(包括本例病人)纳入分析，其中男性 9例，女性 4例，年龄( 62.1±16.3)岁。用药原因多为冠脉造影和(或)支架植入术后，主要发生在用药后 2～14 d，临床症状以神经症状最为常见，其次为发热、瘀斑、尿色深等，部分病例症状不典型，实验室检查以血小板急剧下降，外周涂片见破碎红细胞，轻中度贫血以及乳酸脱氢酶升高最为多见。治疗主要以血浆置换联合糖皮质激素为主，经治疗后大部分病人(11/13)在 2周内好转， 2例预后不佳。结论氯吡格雷诱发 TTP多发生用药后 2周内，其临床表现变异性大，出现血小板急剧下降者应尽早完善相关检查以协助诊断，明确诊断或高风险者须谨慎补充血小板，及早行血浆置换联合糖皮质激素治疗。 |
| 英文摘要: |
| Objective To investigate the clinical characteristics of thrombotic thrombocytopenic purpura (TTP) induced by Clopidogrel.Methods A case of neuropsychiatric changes and platelet decline after clopidogrel after coronary angiography in Suzhou Hospital of Nanjing Medical University was analyzed. Case reports on clopidogrel induced TTP were searched in Wanfang, VIP, CNKI andPubMed databases, and combined with the patient′s information, the clinical manifestations, laboratory examination, treatment and outcome of clopidogrel induced TTP were analyzed and discussed.Results A total of 11 literature were retrieved from the databases, anda total of 13 patients (including this patient) were included in the analysis, there were 9 males and 4 females, with an average age of(62.1±16.3) years. The reasons for drug use were mostly after coronary angiography and/or stent implantation, mainly occurring 2 to 14d after medication. The most common clinical symptoms were nerve symptoms, followed by fever, ecchymosis, urine color depth, etc.Some patients have atypical symptoms. Platelet drops precipitously, broken red blood cells, anemia, and increased lactate dehydrogenase was the most common symptoms of laboratory examinations. The main treatments were plasma exchange combined with glucocorticoids. After treatment, most of the patients (11/13) improved within two weeks, and 2 patients had poor prognosis.Conclusions TTP induced by clopidogrel usually occur within two weeks after medication. The clinical manifestations of TTP are highly variable. The relevant examinations should be improved as soon as possible to assist the diagnosis when Platelet counts of the patients are plummeting.Patients with definite diagnosis or high risk should be careful to supplement platelets, and plasma exchange combined with glucocorticoid therapy should be performed early. |
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