氯吡格雷致白细胞及血小板减少

Leukopenia and thrombocytopenia due to clopidogrel

1例64岁男性患者因冠心病、急性前间壁心肌梗死给予阿司匹林300mg,1次/d、氯吡格雷75mg,1次/d,静脉滴注150万U尿激酶,并给予硝酸异山梨酯、美托洛尔、洛伐他汀。1个月后阿司匹林减量至100mg,1次/d,氯吡格雷剂量不变。7个月后患者出现发热、咽痛,血常规示WBC1.6×109/L,PLT82×109/L。停用氯吡格雷,其他治疗不变,7d后白细胞及血小板计数恢复正常。继续使用阿司匹林、美托洛尔及洛伐他汀,随访1年无复发。

A 64-year-old man received aspirin 300 mg once daily and clopidogrel 75 mg once daily and an IV infusion of urokinase 1.5 million units.Meanwhile he was treated with isosorbide dinitrate,metoprolol,and lovastatin.One month later,aspirin was reduced to 100 mg once daily while clopidogrel was maintained at constant dose.Seven months later,the patient developed fever and sore throat.Routine blood tests revealed the following levels：WBC count 1.6×109/L,PLT count 82×109/L.Clopidogrel was withdrawn and other treatments remained unchanged.Seven days later,the levels of WBC and platelet returned to normal range.Aspirin,metoprolol,and lovastatin were continued and there was no recurrence of thrombocytopenia at one year of follow up.