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

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

上海交通大学附属第六人民医院药剂科, 上海 200233

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

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

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。
- 冠心病 /
- 急性冠脉综合征 /
- 血小板减少症 /
- 抗栓治疗 /
- 抗血小板治疗 /
- 抗凝治疗
Abstract: Objective To summarize the factors and the corresponding treatments for patients with coronary heart disease (CHD) complicated by thrombocytopenia, and provide medical advises for clinical treatment. Methods Literatures and case reports were analyzed and summarized. Results Thrombocytopenia in patient with CHD could be mainly divided into two types, one group was induced by the antithrombotic therapies for CHD, and the other group was caused by some concurrent diseases or combined non-antithrombotic medications. There were different medical decisions and prognoses according to the causes in different groups. Conclusion The treatment strategies of CHD will be considered in the CHD patients with thrombocytopenia. Identifying thrombocytopenia by monitoring the platelet counts in early stage, finding out the causes quickly and providing proper treatments are the key for the prognosis of the patients.
- coronary heart disease /
- acute coronary syndrome /
- thrombocytopenia /
- antithrombotic therapy /
- antiplatelet therapy /
- anticoagulation treatment

[1]	GORE J M, SPENCER F A, GURFINKEL E P, et al. Thrombocytopenia in patients with an acute coronary syndrome (from the global registry of acute coronary events[GRACE])[J]. Am J Cardiol,2009,103(2):175-180
[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
[3]	LIPPI G, PLEBANI M. EDTA-dependent pseudothrombocytopenia: further insights and recommendations for prevention of a clinically threatening artifact[J]. Clin Chem Lab Med,2012,50(8):1281-1285
[4]	O'MALLEY T, LANGHORNE P, ELTON R A, et al. Platelet size in stroke patients[J]. Stroke,1995,26(6):995-999
[5]	VANWIJK M J, VANBAVEL E, STURK A, et al. Microparticles in cardiovascular diseases[J]. Cardiovasc Res,2003,59(2):277-287
[6]	高亚玥, 赵永强, 王书杰. 肝素诱导的血小板减少症发病率及其抗体阳性率调查[J]. 中华内科杂志, 2013, 52(9):734-736
[7]	WARKENTIN T E, SHEPPARD J A, HORSEWOOD P, et al. Impact of the patient population on the risk for heparin-induced thrombocytopenia[J]. Blood,2000,96(5):1703-1708
[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
[22]	MACHIN N, RAGNI M V, COMER D M, et al. Prevalence and correlates of thrombosis in adults with immune thrombocytopenia: An NIS study[J]. Thromb Res,2018,172:80-85
[23]	SINKOVIČ A, MAJAL M. The impact of thrombocytopenia on outcome in patients with acute coronary syndromes: A single center retrospective study[J]. Biomed Res Int,2015,2015:907304
[24]	L S, P, Y C. Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature review[J]. BMC Cardiovasc Disord,2015,15:101

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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

Analysis and management of coronary heart disease complicated by thrombocytopenia

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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

上海交通大学附属第六人民医院药剂科, 上海 200233

English Abstract

Analysis and management of coronary heart disease complicated by thrombocytopenia

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

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留言板

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

Analysis and management of coronary heart disease complicated by thrombocytopenia

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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

上海交通大学附属第六人民医院药剂科, 上海 200233

English Abstract

Analysis and management of coronary heart disease complicated by thrombocytopenia

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

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