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冠心病合并血小板减少的分析与处理策略

李星霞 霍炎 孙习鹏 陈燕 陆瑶华 郭澄

李星霞, 霍炎, 孙习鹏, 陈燕, 陆瑶华, 郭澄. 冠心病合并血小板减少的分析与处理策略[J]. 药学实践与服务, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
引用本文: 李星霞, 霍炎, 孙习鹏, 陈燕, 陆瑶华, 郭澄. 冠心病合并血小板减少的分析与处理策略[J]. 药学实践与服务, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
LI Xingxia, HUO Yan, SUN Xipeng, CHEN Yan, LU Yaohua, GUO Cheng. Analysis and management of coronary heart disease complicated by thrombocytopenia[J]. Journal of Pharmaceutical Practice and Service, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
Citation: LI Xingxia, HUO Yan, SUN Xipeng, CHEN Yan, LU Yaohua, GUO Cheng. Analysis and management of coronary heart disease complicated by thrombocytopenia[J]. Journal of Pharmaceutical Practice and Service, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105
基金项目: 上海交通大学医学院临床药学创新研究院青年项目(CXYJY2019QN003)

Analysis and management of coronary heart disease complicated by thrombocytopenia

  • 摘要: 目的 总结冠心病患者合并血小板减少的因素及相应处理措施,为临床治疗提供参考。 方法 通过对文献及病例报道进行分析和总结。 结果 冠心病患者合并血小板减少主要分两种情况,一种为冠心病抗栓治疗引起的血小板减少,另一种为冠心病患者合并的其他系统疾病或同时应用的非抗栓药物引起的血小板减少。不同原因引起的血小板减少,相应的处理措施及对冠心病患者的预后影响不同。 结论 冠心病合并血小板减少直接影响冠心病的治疗策略,早期监测、识别血小板减少症,快速判断病因并采取适当措施可有效改善冠心病患者的预后。
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    [2] YADAV M, GÉNÉREUX P, GIUSTINO G, et al. Effect of baseline thrombocytopenia on ischemic outcomes in patients with acute coronary syndromes who undergo percutaneous coronary intervention[J]. Can J Cardiol,2016,32(2):226-233
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    [8] 赵永强. 肝素诱导的血小板减少症诊断与治疗常见问题[J]. 中国实用内科杂志, 2013, 33(5):366-368
    [9] CUKER A, AREPALLY G M, CHONG B H, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia[J]. Blood Adv,2019,2(22):3360-3392
    [10] 中国医师协会心血管内科医师分会血栓防治专业委员会, 《中华医学杂志》编辑委员会. 肝素诱导的血小板减少症中国专家共识(2017)[J]. 中华医学杂志, 2018, 98(6):408-417
    [11] SELLENG K, SELLENG S, RASCHKE R, et al. Immune heparin-induced thrombocytopenia can occur in patients receiving clopidogrel and aspirin[J]. Am J Hematol,2005,78(3):188-192
    [12] TAKAHASHI H, MUTO S, NAKAZAWA E, et al. Combined treatment with nafamostat mesilate and aspirin prevents heparin-induced thrombocytopenia in a hemodialysis patient[J]. Clin Nephrol,2003,59(6):458-462
    [13] MEGALOPOULOS A, VASILIADIS K, TSACHALIS T, et al. Recurrent arterial thromboses in a woman with heparin induced thrombocytopenia, successfully managed with iloprost followed by clopidogrel. An alternative therapeutic option for heparin induced thrombocytopenia type II syndrome[J]. Int Angiol,2006,25(1):84-89
    [14] ZAID G, DAWOD S, ROSENSCHEIN U. Immune thrombocytopenic purpura and myocardial infarction: a dilemma of management[J]. Isr Med Assoc J,2013,15(12):775-776
    [15] PETERS M N, PRESS C D, MOSCONA J C, et al. Acute profound thrombocytopenia secondary to local abciximab infusion[J]. Proc (Bayl Univ Med Cent),2012,25(4):346-348
    [16] SAID S M, HAHN J, SCHLEYER E, et al. Glycoprotein IIb/IIIa inhibitor-induced thrombocytopenia: diagnosis and treatment[J]. Clin Res Cardiol,2007,96(2):61-69
    [17] VELIBEY Y, GOLCUK Y, EKMEKCI A, et al. Tirofiban-induced acute profound thrombocytopenia: what is the optimal approach to treatment? Platelets,2015,26(2):197-198
    [18] HUXTABLE L M, TAFRESHI M J, RAKKAR A N. Frequency and management of thrombocytopenia with the glycoprotein IIb/IIIa receptor antagonists[J]. Am J Cardiol,2006,97(3):426-429
    [19] Azarm T, Sohrabi A, Mohajer H, et al. Thrombotic thrombocytopenic purpura associated with clopidogrel: a case report and review of the literature[J]. J Res Med Sci,2011,16(3):353-357
    [20] BENNETT C L, KIM B, ZAKARIJA A, et al. Two mechanistic pathways for thienopyridine-associated thrombotic thrombocytopenic purpura: a report from the SERF-TTP Research Group and the RADAR Project[J]. J Am Coll Cardiol,2007,50(12):1138-1143
    [21] JACOB S, DUNN B L, QURESHI Z P, et al. Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR)[J]. Semin Thromb Hemost,2012,38(8):845-853
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  • 收稿日期:  2019-06-29
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冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105
    基金项目:  上海交通大学医学院临床药学创新研究院青年项目(CXYJY2019QN003)

摘要: 目的 总结冠心病患者合并血小板减少的因素及相应处理措施,为临床治疗提供参考。 方法 通过对文献及病例报道进行分析和总结。 结果 冠心病患者合并血小板减少主要分两种情况,一种为冠心病抗栓治疗引起的血小板减少,另一种为冠心病患者合并的其他系统疾病或同时应用的非抗栓药物引起的血小板减少。不同原因引起的血小板减少,相应的处理措施及对冠心病患者的预后影响不同。 结论 冠心病合并血小板减少直接影响冠心病的治疗策略,早期监测、识别血小板减少症,快速判断病因并采取适当措施可有效改善冠心病患者的预后。

English Abstract

李星霞, 霍炎, 孙习鹏, 陈燕, 陆瑶华, 郭澄. 冠心病合并血小板减少的分析与处理策略[J]. 药学实践与服务, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
引用本文: 李星霞, 霍炎, 孙习鹏, 陈燕, 陆瑶华, 郭澄. 冠心病合并血小板减少的分析与处理策略[J]. 药学实践与服务, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
LI Xingxia, HUO Yan, SUN Xipeng, CHEN Yan, LU Yaohua, GUO Cheng. Analysis and management of coronary heart disease complicated by thrombocytopenia[J]. Journal of Pharmaceutical Practice and Service, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
Citation: LI Xingxia, HUO Yan, SUN Xipeng, CHEN Yan, LU Yaohua, GUO Cheng. Analysis and management of coronary heart disease complicated by thrombocytopenia[J]. Journal of Pharmaceutical Practice and Service, 2020, 38(1): 77-80. doi: 10.3969/j.issn.1006-0111.201906105
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