阿加曲班与尿激酶联用致低纤维蛋白原血症

Hypofibrinogenemia induced by argatroban combined with urokinase

1例64岁男性患者因下肢深静脉血栓形成接受下肢静脉+下腔静脉造影以进行影像学诊断。造影前后分别予那屈肝素钙(3 d)和肝素钠抗凝。手术第3天,凝血功能检查示纤维蛋白原(FIB)2.78 g/L,活化部分凝血活酶时间(APTT)26.4 s,加用阿加曲班1.5μg/(kg·min)持续静脉泵入(22 h/d)和尿激酶60万U鞘管静脉泵入(时长2 h)。手术第4天,凝血功能检查示FIB 0.1 g/L,APTT 94.7 s。考虑药物所致,停用尿激酶,将阿加曲班减量至1.0μg/(kg·min),加用人纤维蛋白原。手术第5天,凝血功能检查示FIB 0.49 g/L、APTT 51.2 s,停用阿加曲班。手术第8天,凝血功能检查示FIB 1.30 g/L、APTT 31.8 s,给予新鲜冰冻血浆750 ml静脉滴注、2次/d。手术第11天,凝血功能检查示FIB 2.40 g/L,APTT 28.3 s。

A 64‑year‑old male patient underwent diagnostic imaging of lower extremity venography plus inferior vena cava angiography due to deep vein thrombosis of lower extremity.Nadroparin calcium anticoagulation was given for 3 days before the operation,and heparin sodium anticoagulation was given after the operation.On the 3rd day of the operation,the coagulation function test showed fibrinogen(FIB)2.78 g/L,activated partial thromboplastin time(APTT)26.4 s.Continuous intravenous pumping of argatroban 1.5μg/(kg·min)(22 hours daily)and intravenously pumping of urokinase 600000 U(lasting 2 hours)were given.On the 4th day of operation,the coagulation function test showed FIB 0.1 g/L and APTT 94.7 s.Considering the possible relation to drugs,urokinase was stopped,the dose of argatroban was reduced to 1.0μg/(kg·min),and human fibrinogen was added.On the 5th day of operation,the coagulation function test showed FIB 0.49 g/L and APTT 51.2 s,and argatroban was stopped.On the 8th day of operation,the coagulation function test showed FIB 1.30 g/L and APTT 31.8 s,and fresh frozen plasma 750 ml was given twice daily by intravenous infusion.On the 11th day of operation,the coagulation function test showed FIB 2.40 g/L and APTT 28.3 s.