2023 年第 8 期 第 18 卷

替罗非班致极重度血小板减少救治1例并文献复习

Tirofiban-induced severe thrombocytopenia: a case report and literature review

作者：王刚李泽亚叶智帅黄榕翀

英文作者：Wang Gang Li Zeya Ye Zhishuai Huang Rongchong

单位：首都医科大学附属北京友谊医院心血管中心，北京100050

英文单位：Cardiovascular Center Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂；替罗非班；血小板减少

英文关键词：PlateletglycoproteinⅡb/Ⅲareceptorantagonist;Tirofiban;Thrombocytopenia

• 摘要：

• 替罗非班作为血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂，通过抑制纤维蛋白原与血小板结合，抑制血小板之间相互作用和血栓形成，目前指南推荐在急性冠状动脉综合征及血栓负荷较高的高危患者中应用。使用替罗非班24 h内出现的血小板轻度减少（＜100×109/L）及重度减少（＜50×109/L），一般在停药后平均2.1 d内可自行恢复；极重度减少（＜20×109/L）在人群应用中相对罕见。血小板减少所致出血多以皮肤黏膜出血为主，严重时可出现消化道出血、肺泡内出血甚至失血性休克。本文介绍1例经皮腔内冠状动脉成形术后应用替罗非班致极重度血小板减少，并出现泌尿系统、皮肤黏膜及消化系统出血患者的临床资料，以提高临床医师对替罗非班致血小板减少规范化诊疗的认知。

• Tirofiban is a platelet glycoprotein Ⅱb/Ⅲa receptor antagonist, which inhibits interactions of platelets and thrombus formation through inhibiting the binding of fibrinogen to platelets. The application of tirofiban has been recommended in patients with acute coronary syndrome and high thrombotic risk. The mild thrombocytopenia (<100×109/L) and severe thrombocytopenia (<50×109/L) induced by tirofiban were usually recovered within 2.1 d after drug withdrawal. Extremely severe thrombocytopenia (<20×109/L) is relatively rare. The hemorrhage caused by thrombocytopenia is mainly in skin and mucous membrane. In severe cases, gastrointestinal hemorrhage, alveolar hemorrhage, and even hemorrhagic shock may occur. This paper introduces the clinical data of a patient with extremely severe thrombocytopenia caused by tirofiban after percutaneous transluminal coronary angioplasty and bleeding of urinary system, skin mucosa and digestive system, so as to improve the clinicians′ awareness of standardized diagnosis and treatment of thrombocytopenia caused by tirofiban.