替格瑞洛致血小板减少的文献病例分析

Literature case analysis of thrombocytopenia induced by ticagrelor

目的:探讨和分析替格瑞洛致血小板减少的发生情况和特点,为临床安全用药提供参考。方法:检索建库至2023年1月收录在PubMed、Embase、中国知网、万方和维普期刊数据库有关替格瑞洛致血小板减少的病例报道并对患者的基本信息、药物的使用情况、血小板计数、并发症及其转归等进行统计分析。结果:共纳入9篇文献合计9例患者,其中男7例(77.8%),女2例(22.2%),年龄31~87岁,≥60岁的有6例(66.7%)。发现血小板减少的时间为用药后6 h至4个月,其中6例(66.7%)为1个月内发生。血小板计数的最低值为(0~40)×10^(9)L^(-1),其中<30×10^(9)L^(-1)的有7例(77.8%),3例(33.3%)并发血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura, TTP)。经停药、调整治疗方案和对症治疗后有8例(88.9%)血小板计数恢复正常或好转,仅1例(11.1%)最终死于二次应用替格瑞洛后再发血小板减少。结论:血小板减少是替格瑞洛罕见的不良反应,且以严重血小板减少居多,可并发TTP。临床在使用过程中应定期监测血小板计数,尤其是用药后1个月内。一旦发现异常及时停药并视患者病情调整抗血小板治疗方案,必要时可予以输注血小板和血浆置换等处理。

OBJECTIVE To explore and analysis the occurrence and characteristics of thrombocytopenia induced by ticagrelor in order to provide references for clinical safe drug use.METHODS The case reports of thrombocytopenia induced by ticagrelor published in PubMed,Embase,CNKI,Wanfang and VIP were searched from the establishment of each database to January 2023,and statistical analysis was conducted on patients’basic information,drug use,platelet count,complications and outcomes.RESULTS A total of 9 cases from9 articles were identified,including 7 males(77.8%)and 2 females(22.2%).Patients were aged from31 to 87 years old,and 6 cases(66.7%)were≥60 years old.Thrombocytopenia was found from6 hours to 4 months after medication,of which 6 cases(66.7%)occurred within 1 month.The trough value of platelet count was(0-40)×10^(9) L^(-1),of which7 cases(77.8%)were<30×10^(9) L^(-1),and3 cases(33.3%)had thrombotic thrombocytopenic purpura(TTP).The platelet count of 8 cases(88.9%)returned to normal or improved after drug withdrawal,adjustment of treatment regimen and symptomatic treatment,and only 1 case(11.1%)died of recurrent thrombocytopenia after secondary administration of ticagrelor.CONCLUSION Thrombocytopenia is a rare adverse reaction of ticagrelor,and most of them are severe,which can be complicated with TTP.Platelet count should be tested regularly during clinical use,especially within 1 month after medication.In case of any abnormality,ticagrelor should be stopped in time and the antiplatelet therapy regimen should be adjusted according to the patient’s condition.If necessary,platelet transfusion and plasma exchange can be performed.