Hayashi K, Matsuda H, Honda M, Ozawa Y, Tokuyama H, Okubo K, Takamatsu I, Kanda T, Tatematsu S, Homma K, Saruta T
Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
J Hum Hypertens. 2002 Mar;16(3):199-203. doi: 10.1038/sj.jhh.1001327.
Haemorrhagic diathesis develops in chronic renal failure, in which calcium antagonists are used widely as antihypertensive agents. Although calcium antagonists are reported to impair platelet function, it has not been examined whether calcium antagonists alter bleeding time. The present study was conducted to clarify whether calcium antagonists affect bleeding time in chronic renal failure. Patients with chronic renal failure without and with calcium antagonists were enrolled (n = 156), and bleeding time (Ivy's method) as well as blood parameters (BUN, creatinine, platelet counts, and haemoglobin) were compared in patients with normal and prolonged bleeding time. Among patients not taking calcium antagonists (n = 34), three cases manifested prolonged bleeding time, whereas abnormal bleeding time was observed in 31 patients out of 122. Positive correlations were observed between bleeding time and BUN in both calcium antagonist-untreated (r = 0.46) and -treated groups (r = 0.25). The odds ratio for prolongation of bleeding time in patients taking calcium antagonists was 3.52 (95% CI, 1.01-12.33). In 12 calcium antagonist-treated patients with prolonged bleeding time, the withdrawal of calcium antagonists markedly shortened bleeding time (from 11.3 +/- 0.8 to 5.4 +/- 0.8 min, P < 0.05, n = 12). In contrast, in the additional group (n = 9), the continued treatment with calcium antagonists had no effect on bleeding time (from 11.7 +/- 0.9 to 10.0 +/- 1.0 min). Despite the inhibitory effect of calcium antagonists on bleeding time, no clinically serious events associated with haemorrhagic diathesis developed. In conclusion, calcium antagonists prolong bleeding time in patients with chronic renal failure. The subclinical (laboratory) effect of calcium antagonists however is not necessarily associated with haemorrhagic events of clinical significance.
慢性肾衰竭患者会出现出血倾向，而钙拮抗剂在该病症中被广泛用作抗高血压药物。尽管有报道称钙拮抗剂会损害血小板功能，但尚未研究其是否会改变出血时间。本研究旨在阐明钙拮抗剂是否会影响慢性肾衰竭患者的出血时间。纳入了未服用和正在服用钙拮抗剂的慢性肾衰竭患者（n = 156），并比较了出血时间正常和延长的患者的出血时间（艾维法）以及血液参数（血尿素氮、肌酐、血小板计数和血红蛋白）。在未服用钙拮抗剂的患者（n = 34）中，3例出现出血时间延长，而在122例服用钙拮抗剂的患者中，有31例出现异常出血时间。在未服用钙拮抗剂组（r = 0.46）和服用钙拮抗剂组（r = 0.25）中，均观察到出血时间与血尿素氮之间存在正相关。服用钙拮抗剂的患者出血时间延长的优势比为3.52（95%可信区间，1.01 - 12.33）。在12例服用钙拮抗剂且出血时间延长的患者中，停用钙拮抗剂后出血时间明显缩短（从11.3 ± 0.8分钟缩短至5.4 ± 0.8分钟，P < 0.05，n = 12）。相比之下，在另一组（n = 9）中，继续使用钙拮抗剂对出血时间没有影响（从11.7 ± 0.9分钟变为10.0 ± 1.0分钟）。尽管钙拮抗剂对出血时间有抑制作用，但并未发生与出血倾向相关的严重临床事件。总之，钙拮抗剂会延长慢性肾衰竭患者的出血时间。然而，钙拮抗剂的亚临床（实验室）效应不一定与具有临床意义的出血事件相关。
