替罗非班诱导血小板减少症临床分析

Clinical analysis of tirofiban induced thrombocytopenia

目的探讨替罗非班诱导的血小板减少症(GIT)临床特点、发病机制、诊断、处置策略及预后。方法收集解放军第九八三医院心血管内科2008年1月至2018年1月26例应用替罗非班治疗后出现急性血小板减少的急性冠脉综合症(ACS)患者临床资料,记录患者的人口学资料、冠状动脉粥样硬化性心脏病(冠心病)危险因素(家族史、高血压、糖尿病及吸烟史等)、实验室检查,血小板减少发生、恢复前后临床症状、体征变化及与各种药物应用的时间关系,对其进行统计学分析。结果①26例患者入院时血小板在正常范围,应用替罗非班后发生GIT平均5.3±4.5 h,发生率1.9%,其中轻度GIT 16例(1.2%),重度GIT 7例(0.5%),极重度GIT 3例(0.2%);②血小板最低计数为8.4×109/L,平均最低血小板计数57.3±27.3×109/L,停用替罗非班后平均54.0±24.8 h血小板计数恢复正常;③18例GIT发生出血事件,发生率为69.2%,其中轻微出血16例(61.5%),严重出血2例(7.7%);8例(30.8%)无出血事件发生,其中2例(7.7%)发生过敏反应。结论①GIT多在替罗非班应用早期(1～24 h)出现,应注意及早检测血小板;②各种出血事件非GIT特异性表现,部分以过敏反应为首发表现;③发生GIT时应综合评估病情,慎重停用其他抗栓药物,避免恶化ACS原发病。

Objective To investigate the clinical features,pathogenesis,diagnosis,management strategy and prognosis of tirofiban-induced thrombocytopenia(GIT).Methods Clinical data about 26 patients diagnosed as acute coronary syndrome(ACS)with acute thrombocytopenia after tirofiban treatment was collected.The demographic data of the patients,the risk factors of coronary heart disease(family history,hypertension,diabetes and smoking history,etc.),laboratory test and examination,the changes of clinical symptoms and signs before and after the occurrence and recovery of thrombocytopenia,and the time relationship with the applications of various drugs were recorded and statistically analyzed.Results(1)At the time of admission,platelet levels were normal in 26 patients.The average GIT time after treatment with tirofiban was 5.3±4.5 h,with an incidence of 1.9%,including 16 cases of mild GIT(1.2%)and 7 cases of severe GIT(0.5%).Severe GIT3 cases(0.2%).(2)The lowest platelet count was 8.4×10^9/L,the average minimum platelet count was 57.3±27.3×10^9/L,and the platelet count returned to normal after an average of 54.0±24.8 h after discontinuation of tirofiban.(3)Hemorrhagic events occurred in 18 patients with GIT,with an incidence of 69.2%,including 16(61.5%)minor hemorrhages and 2(7.7%)severe bleeding.Eight patients(30.8%)had no bleeding events,and 2 of them(7.7%)developed an allergic reaction.Conclusion(1)GIT is more common in the early application of tirofiban(1-24h),attention should be paid to early detection of platelets.(2)Bleeding events are not specific for GIT,and sometimes allergic reactions are the first manifestations of GIT.(3)it should be considerate to make recommendations of withdrawing of other antithrombotic when GIT occurred in order to avoid to worsen the primary disease of ACS.