沙格雷酯与替格瑞洛联用致血小板减少

Thrombocytopenia induced by the combination use of sarpogrelate and ticagrelor

1例73岁男性糖尿病合并周围血管病变和神经病变患者,因手足麻木发凉伴下肢疼痛加重在以往替格瑞洛、硝苯地平控释片、坎地沙坦酯、美托洛尔缓释片和单硝酸异山梨酯分散片治疗的基础上加用沙格雷酯。12 d后患者出现口腔黏膜出血,16 d后血小板计数(PLT)7×10^(9)/L。加用沙格雷酯前患者PLT 229×10^(9)/L。患者既往曾单独服用沙格雷酯或替格瑞洛,均未发生出血现象,也无血细胞及血小板异常史。考虑血小板减少为沙格雷酯及替格瑞洛联用所致,停用2药,给予血小板血浆300 ml,第2天给予阿司匹林肠溶片100 mg口服、1次/d。19 d后患者血小板恢复至187×10^(9)/L。

A 73‑year‑old male patient with diabetic mellitus complicated with peripheral vascular lesions and neuropathy received sarpogrelate on the basis of previous treatments with ticagrelor,nifedipine controlled‑release tablets,candesartan cilexetil,metoprolol tartrate sustained‑release tablets,and isosorbide mononitrate dispersible tablets for aggravated numbness and coldness of hands and feet with lower limb pain.Oral mucosal bleeding occurred after 12 days of treatments and platelet count(PLT)was 7×10^(9)/L after 16 days of treatments.Before sarpogrelate was added,PLT was 229×10^(9)/L.The patient had taken ticagrelor or sarpogrelate alone in the past,no bleeding occurred,and the patient had no history of abnormal blood cells and platelets.Considering that the thrombocytopenia was caused by the combination use of sarpogrelate and ticagrelor,the 2 drugs were stopped,300 ml of platelet plasma was given that day,and aspirin enteric-coated tablets 100 mg orally once daily was given on the second day.Nineteen days later,the PLT recovered to 187×10^(9)/L。