经皮冠状动脉介入术后应用依替巴肽致重度血小板减少1例

Severe thrombocytopenia induced by eptifibatide after percutaneous coronary intervention:a case report

本文报道1例急性冠状动脉综合征合并心房颤动患者经皮冠状动脉介入术后出现重度血小板减少并发消化道出血的病例。患者在经皮冠状动脉介入围手术期同时应用阿司匹林肠溶片、硫酸氢氯吡格雷片、依替巴肽注射液及肝素钠注射液抗血栓治疗,术后即发生血小板减少并发消化道出血。临床药师与医师共同查找文献,通过患者的血小板减少特点,判定依替巴肽注射液与患者的血小板减少相关性大。通过相应处理,患者血小板计数恢复,消化道出血好转。结合药物的药理特性和作用机制,综合考虑患者的病情,在患者出院时为其制定个体化的抗血栓方案。此例患者的诊治过程提示临床药师在工作中,需根据抗血栓药物的有效性和安全性,积极开展药学服务,为复杂病例提供个体化的药物治疗管理。

This paper reports a case of severe thrombocytopenia and gastrointestinal bleeding,with acute coronary syndrome complicated with atrial fibrillation after percutaneous coronary intervention.During the perioperative period of percutaneous coronary intervention,the patient was simultaneously treated with aspirin enteric⁃coated tablets,clopidogrel bisulfate tablets,eptifibatide injection and heparin sodium injection for antithrombotic therapy,and thrombocytopenia complicated with gastrointestinal bleeding occurred immediately after surgery.Clinical pharmacists and doctors searched literatures together,and determined that eptifibatide injection was highly correlated with thrombocytopenia in this patient based on the characteristics of thrombocytopenia.With appropriate management,the patient′s platelet count recovered and gastrointestinal bleeding improved.According to the pharmacological characteristics,mechanism of action and the patient′s condition,individualized antithrombotic plan was formulated for the patient when he was discharged from hospital.The diagnosis and treatment process of this patient suggests that clinical pharmacists should actively carry out pharmaceutical care according to the effectiveness and safety of antithrombotic drugs,and provide individualized drug treatment management for complex cases.