依达赛珠单抗逆转达比加群酯所致消化道出血  

Idarucizumab for reversal of dabigatran etexilate-induced gastrointestinal bleeding

作　　者：林琦 董淑杰[1] 李蕾[2] 王琨[3] 史均宝[4] 杨丽[1] Lin Qi;Dong Shujie;Li Lei;Wang Kun;Shi Junbao;Yang Li(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Cardiology,Peking University Third Hospital,Beijing 100191,China;Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China;Department of Nephrology,Peking University Third Hospital,Beijing 100191,China;the Pharmacy Department of Peking University Third Hospital from Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]北京大学第三医院药剂科,北京100191 [2]北京大学第三医院心内科,北京100191 [3]北京大学第三医院消化内科,北京100191 [4]北京大学第三医院肾内科,北京100191 [5]福建医科大学附属协和医院药学部,福州350001

出　　处：《药物不良反应杂志》2025年第1期53-55,共3页Adverse Drug Reactions Journal

基　　金：国家自然科学基金(72304009)。

摘　　要：1例82岁心房颤动、心力衰竭女性患者近6年服用达比加群酯(110 mg、2次/d)抗凝治疗。2个月前患者下肢水肿加重,尿量减少。考虑心力衰竭加重,给予托拉塞米片和螺内酯片利尿治疗,症状改善不明显。2 d前患者出现全身散在瘀斑,排糊状黑便,尿量减少至200 ml/d。实验室检查:血红蛋白(Hb)63 g/L,凝血酶原时间(PT)39.5 s,活化部分凝血活酶时间(APTT)117.2 s,凝血酶时间(TT)>300 s,国际标准化比值(INR)3.64,纤维蛋白原(Fib)无法测出。考虑为达比加群酯引起的凝血功能障碍,消化道出血。停用达比加群酯,给予依达赛珠单抗注射液2.5 g静脉滴注2次。治疗后消化道出血停止,PT 12.7 s、APTT 42.4 s、TT 18.8 s、INR 1.18、Fib 2.67 g/L。8 d后,患者心功能改善,皮肤瘀斑消退,Hb 84 g/L、PT 14 s、APTT 37.8 s、TT 41.2 s、INR 1.3、Fib 2.26 g/L,粪潜血试验阴性。An 82-year-old female patient with atrial fibrillation and heart failure was treated with dabigatran etexilate 110 mg twice daily for 6 years.Two months ago,the patient′s lower limb edema was aggravated and urine output was reduced.Considering the worsening of the patient′s heart failure,torasemide tablets and spironolactone tablets were given,but her symptoms were not improved.Two days ago,the patient had scattered petechiae on the whole skin,tarry stools,and reduced urine(200 ml daily).Laboratory tests showed hemoglobin(Hb)63 g/l,prothrombin time(PT)39.5 s,activated partial thromboplastin time(APTT)117.2 s,thrombin time(TT)>300 s,and international normalized ratio(INR)3.64;the fibrinogen(Fib)could not be measured.Coagulation dysfunction and gastrointestinal bleeding caused by dabigatran etexilate were considered.Dabigatran etexilate was discontinued,and intravenous infusion of idarucizumab injection(2.5 g)was given twice.Then gastrointestinal bleeding in the patient disappeared and laboratory tests showed PT 12.7 s,APTT 42.4 s,TT 18.8 s,INR 1.18,and Fib 2.67 g/L.After 8 days,the patient′s cardiac function was improved,the skin ecchymosis subsided,and laboratory tests showed Hb 84 g/L,PT 14 s,APTT 37.8 s,TT 41.2 s,INR 1.3,Fib 2.26 g/L,and negative fecal occult blood test.

关 键 词：达比加群 胃肠出血 依达赛珠单抗 

分 类 号：R54[医药卫生—心血管疾病]