44例氯吡格雷相关性血小板减少症的文献病例分析  

Literature Case Analysis of 44 Patients with Thrombocytopenia Induced by Clopidogrel

作　　者：江璐[1] 许梦帆 夏凡[1] 朱建国[1] 谢诚[1] JIANG Lu;XU Mengfan;XIA Fan;ZHU Jianguo;XIE Cheng(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215000;Department of Pharmacy,Xinyang Central Hospital,Xinyang 465299)

机构地区：[1]苏州大学附属第一医院药学部,苏州215000 [2]河南省信阳市中心医院药学部,信阳465299

出　　处：《医药导报》2024年第2期304-308,共5页Herald of Medicine

基　　金：国家临床重点专科(临床药学)建设项目(国卫办医函〔2018〕292号)。

摘　　要：目的探讨氯吡格雷相关性血小板减少症的发生特点,为临床安全用药提供参考。方法检索建库至2022年11月收录在PubMed、Embase、中国知网、万方和维普期刊数据库有关氯吡格雷致血小板减少症的病例报道并对其发生情况进行整理和分析。结果共纳入43篇文献合计44例患者;男30例(68.2%),女14例(31.8%);年龄37~88(65.0±11.4)岁,其中≥60岁30例(68.2%)。发生血小板减少症的时间为用药后8 h~9个月,其中29例(65.9%)出现在2周内。31例(70.5%)表现为重度血小板减少,38例(86.4%)伴有并发症,其中24例(63.2%)表现为出血,19例(50.0%)表现为血栓性血小板减少性紫癜。经停药和对症治疗后41例(93.2%)血小板计数恢复正常,3例(6.8%)死亡。结论氯吡格雷相关性血小板减少症以重度血小板减少居多,且常伴发出血或血栓性血小板减少性紫癜,但整体转归良好。临床在使用该药的前2周内应密切监测患者的血小板计数,一旦发现异常及时停药并予以对症处理。Objective To investigate the characteristics of clopidogrel-associated thrombocytopenia to provide references for clinically safe drug use.Methods The case reports of thrombocytopenia induced by clopidogrel published in PubMed,Embase,CNKI,Wanfang and VIP were searched from the establishment of each database to November 2022,and their occurrence was collated and analysed.Results A total of 44 cases from 43 articles were identified and included in the analysis.There were 30 males(68.2%)and 14 females(31.8%).Ages ranged from 37 to 88(65.0±11.4)years,of which 30(68.2%)were≥60 years old.Thrombocytopenia was found from 8 h to 9 months after medication,of which 29 cases(65.9%)appeared within two weeks.There were 31 cases(70.5%)with severe thrombocytopenia and 38 cases(86.4%)with complications,of which 24 cases(63.2%)with bleeding and 19 cases(50.0%)with thrombotic thrombocytopenic purpura(TTP).The platelet count of 41 cases(93.2%)returned to normal after drug withdrawal and symptomatic treatment,and 3 cases(6.8%)died finally.Conclusion Clopidogrel related thrombocytopenia is mainly severe thrombocytopenia,and often accompanied by bleeding or thrombotic thrombocytopenic purpura(TTP),but the overall outcome is good.Platelet count should be regularly monitored within the first two weeks after medication.Clopidogrel should be stopped and symptomatic treatment should be given in case of any abnormality.

关 键 词：氯吡格雷 血小板减少症 血栓性血小板减少性紫癜 药品不良反应 文献病例分析 

分 类 号：R973[医药卫生—药品] R551[医药卫生—药学]