高君 侯毅 陈楠

摘 要 目的：探讨替罗非班致极重度血小板减少症的临床特点、防治策略以及临床药师在其中发挥的作用。方法：查阅国内外文献，对1例替罗非班导致的极重度血小板减少症的病例进行分析。结果：患者在应用替罗非班24 h内出现血小板计数严重下降，降至1.00×109/L，伴穿刺部位瘀斑出血，及时停用替罗非班后，血小板计数于停药后第5天恢复至正常范围内。结论：应用替罗非班的1～24 h内应加强血小板监测以及出血情况监护。临床药师应协同临床医生关注使用此类药物的患者，对可能出现的风险进行严格监控。

关键词 替罗非班 极重度血小板减少症 药品不良反应

中图分类号：R973.2 文献标志码：B 文章编号：1006-1533（2021）11-0071-04

Clinical pharmacist participation in a case of extreme severe thrombocytopenia induced by tirofiban

GAO Jun1，2*， HOU Yi3， CHEN Nan1，2**[1. Department of Pharmacy， the Peoples Hospital of Henan University of Chinese Medicine （the Peoples Hospital of Zhengzhou）， Zhengzhou 450003， China； 2. the Fifth Clinical Medical College of Henan University of Chinese Medicine ， Zhengzhou 450003， China； 3. Department of Pharmacy， the Seventh Peoples Hospital of Zhengzhou， Zhengzhou 450000， China]

ABSTRACT Objective： To discuss the characteristics， prevention and treatment strategies of extremely severe thrombocytopenia induced by tirofiban， and the role of clinical pharmacists in it. Methods： By reviewing domestic and foreign literature， the case of extremely severe thrombocytopenia caused by tirofiban was analyzed. Results： Extremely severe thrombocytopenia occurred within the 24 hours after application of tirofiban and his platelet counts dropped to 1.00×109/L， accompanied by ecchymosis and bleeding at the puncture site. After tirofiban was stopped in time， the platelet count returned to normal range on the 5th day after stopping the drug. Conclusion： The monitoring of platelet and bleeding should be strengthened within 1-24 hours after application of tirofiban. Clinical pharmacists should cooperate with clinicians to pay attention to patients using such drug and strictly monitor the possible risks.

KEy WORDS tirofiban； extremely severe thrombocytopenia； adverse drug reaction

冠狀动脉粥样硬化不稳定斑块突然破裂、糜烂，导致血栓形成，是急性冠脉综合征（acute coronary syndrom， ACS）的主要原因。而血小板激活和聚集在其发病过程中起着非常关键的作用，因此抗血小板治疗在冠心病的治疗过程中至关重要。而血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂（platelet glycoprotein IIb/IIIa inhibitor， GPI），是目前效应最强的抗血小板聚集药物，国内常用的代表药物是替罗非班，其应用于ACS及经皮冠脉介入治疗（percutaneous coronary intervention， PCI）过程中的安全性和有效性被广泛证实[1]。但该类药物可引起血小板减少症（GP IIb/IIIa inhibitor-induced thrombocytopenia， GIT），多数报道GIT发生后均立即给予停用抗血栓药物，包括替罗非班、肝素类制剂及其他抗血小板药物。但一旦停用抗血栓药物，可能增加PCI术后形成支架内亚急性血栓风险。因而，当GIT发生时，合理的应对策略尤为重要，一方面应避免严重出血并发症的发生，另一方面应避免因停用抗血栓药物而增加的血栓形成风险。……