Cox N H, Walsh M L, Robson R H
Department of Dermatology, Cumberland Infirmary, Carlisle, UK.
Clin Exp Dermatol. 2009 Jun;34(4):487-91. doi: 10.1111/j.1365-2230.2008.03048.x. Epub 2008 Dec 15.
Surgical bleeding and occasionally purpura due to calcium-channel blockers have been described.
To present cases in whom purpura or internal bleeding due to calcium-channel blockers was a presenting feature, including one subject with drug-induced haematuria and haematospermia due to amlodipine and one with the Rumpel-Leede sign. Further support for a true association was sought in a pilot study using Hess testing to provoke purpuric skin lesions.
Four representative cases presenting due to purpura or bleeding are described, all of whom had an abnormal Hess test. A further 19 patients taking calcium-channel blockers and 13 control subjects were also tested.
Of 19 patients on calcium-channel blockers, 16 had either abnormal Hess results (n = 13) or marked acral purpura (n = 3) after a Hess test procedure. A similar abnormal response, of milder degree, occurred in only 2 of 13 control subjects.
The high frequency of purpura shown in this study, whether spontaneous or provoked, suggests that this is a pharmacological class effect rather than idiosyncratic. Purpura in patients taking these drugs may be a clue to diagnosis of internal or postsurgical bleeding. We conclude that purpura related to calcium-channel antagonists is probably underestimated, but further studies are needed to identify the mechanism by which this occurs.
已有关于钙通道阻滞剂导致手术出血以及偶尔出现紫癜的报道。
介绍以紫癜或因钙通道阻滞剂引起的内出血为首发特征的病例，包括1例因氨氯地平导致药物性血尿和血精的患者以及1例出现束臂试验阳性的患者。在一项使用赫斯试验诱发紫癜性皮肤病变的初步研究中，寻求对这种真正关联的进一步支持。
描述了4例因紫癜或出血就诊的代表性病例，所有患者的赫斯试验均异常。还对另外19名服用钙通道阻滞剂的患者和13名对照受试者进行了测试。
在19名服用钙通道阻滞剂的患者中，16名在赫斯试验后出现赫斯结果异常（n = 13）或明显的肢端紫癜（n = 3）。在13名对照受试者中，只有2名出现了程度较轻的类似异常反应。
本研究中显示的紫癜高发生率，无论是自发的还是诱发的，表明这是一种药理学类效应而非特异质性反应。服用这些药物的患者出现紫癜可能是诊断内出血或术后出血的线索。我们得出结论，与钙通道拮抗剂相关的紫癜可能被低估了，但需要进一步研究以确定其发生机制。
