依替巴肽致血小板减少文献病例分析

Literature analysis of thrombocytopenia induced by eptifibatide

目的分析依替巴肽致血小板减少的临床特点。方法检索中国知网、万方、维普、PubMed、Web of Science和Embase数据库(截至2020年5月31日),收集依替巴肽致血小板减少的病例报告类文献,记录患者一般情况、依替巴肽应用情况、血小板减少发生情况、临床处置和转归等信息,进行描述性统计分析。结果纳入分析的患者共30例,男性17例,女性13例;年龄34~86岁,平均63岁;依替巴肽用药指征为经皮冠状动脉介入治疗者20例,急性冠状动脉综合征者9例,盆腔恶性肿瘤切除术前心脏评估者1例。29例有合并用药记录者均联用了肝素类药物,同时联用阿司匹林者25例,氯吡格雷者22例。30例患者应用依替巴肽前血小板计数(PLT)为(129~398)×10^(9)/L,用药后降至(<1~78)×10^(9)/L,轻度、重度、极重度血小板减少者分别为1、2、27例。应用依替巴肽至发生血小板减少的时间,29例为1~24 h(≤6 h者21例),1例为174 h(连续用药168 h)。30例患者中10例无临床症状,14例有出血症状(其中5例合并血红蛋白减少),1例仅出现血红蛋白减少,5例出现其他症状。除1例患者发生血小板减少前已停药6 h外,余29例患者均在血小板减少发生后立即停用依替巴肽;7例未给予其他干预,1例给予糖皮质激素和咖啡酸片治疗,其余22例给予输注血小板、输注红细胞等治疗。除1例患者无血小板减少好转时间记录外,29例血小板减少于停药后7 h~12 d好转。3例患者在停药后发现血栓形成(1例死亡)。2例患者再次应用依替巴肽后再次发生血小板减少,停药并治疗后均好转,但1例最终因感染性休克、多器官衰竭等死亡。结论依替巴肽可导致极重度血小板减少,多发生在用药后6 h内,可无出血症状。停用依替巴肽并视病情给予输注血小板等治疗,症状多可好转。

Objective To analyze the clinical characteristics of thrombocytopenia induced by eptifibatide.Methods Databases such as CNKI,Wanfang,VIP,PubMed,Web of Science,and Embase as of May 31st,2020 were searched and case reports on eptifibatide‑induced thrombocytopenia were collected.Clinical information including patient′s basic characteristics,eptifibatide application,the occurrence of thrombocytopenia,management and outcomes,etc.were collected and analyzed by descriptive statistical method.Results A total of 30 patients were enrolled in the study,including 17 males and 13 females,aged from 34 to 86 years with an average age of 63 years.Eptifibatide was applied because of percutaneous coronary intervention in 20 patients,acute coronary syndromes in 9 patients,and pre‑operative cardiology evaluation in 1 patient.The 29 patients with combined medication records were all treated with heparins,of which 25 received aspirin and 22 received clopidogrel at the same time.The platelet count(PLT)in 30 patients was(129‑398)×10^(9)/L before eptifibatide treatment and decreased to(<1‑78)×10^(9)/L after treatment;1,2,and 27 cases were with mild,severe,and profound thrombocytopenia,respectively.Time from eptifibatide application to thrombocytopenia occurrence was 1‑24 h in 29 patients(≤6 h in 21 patients)and 174 h in 1 patient(continuous application for 168 h).Of the 30 patients,10 had no clinical symptoms,14 had bleeding symptoms(5 of which were accompanied by decreased hemoglobin),1 had only decreased hemoglobin,and 5 had other symptoms.Except 1 patient who had stopped eptifibatide 6 hours before thrombocytopenia,the other 29 patients stopped eptifibatide immediately after thrombocytopenia occurrence;7 patients did not receive any other intervention,1 patient was treated with glucocorticoid and caffeic acid tablets,and the other 22 patients were treated with platelet infusion and red blood cell infusion,etc.Except 1 patient with no record of time to thrombocytopenia improvement,thrombocytopenia was improved 7 hours to 12 days later in the other 29 patients.Three patients were found to have thrombosis after eptifibatide discontinua‑tion and 1 of them died.Thrombocytopenia recurred in 2 patients after the second application of eptifiba‑tide and was all improved after drug withdrawal and treatments but 1 patient died of septic shock and multiple organ failure finally.Conclusions Eptifibatide might cause severe thrombocytopenia,which usually occurred within 6 hours after application and were without bleeding symptoms sometimes.Thrombocytope‑nia could be improved if eptifibatide was stopped and platelet transfusion was given according to the pa‑tient′s condition.