Montalto Massimo, Porto Italo, Gallo Antonella, Camaioni Claudia, Della Bona Roberta, Grieco Antonio, Crea Filippo, Landolfi Raffaele
Institute of Internal Medicine, Catholic University of Rome, 00168 Rome, Italy.
Int J Vasc Med. 2011;2011:867964. doi: 10.1155/2011/867964. Epub 2011 Aug 11.
Dual antiplatelet therapy with aspirin plus thienopyridines has become the standard treatment of patients undergoing coronary stenting. Clopidogrel has mostly replaced the use of ticlopidine due to its more favourable adverse event profile. However, also the use of clopidogrel is not without side effects. Clopidogrel major adverse events are represented by marrow suppression, manifesting with aplastic anaemia, thrombocytopenia and neutropenia. When clopidogrel toxicity occurs, there are few and unsubstantiated alternative treatments and thus, in these cases, medical decisions may be very difficult. We report a case of clopidogrel-induced bone marrow toxicity manifesting with severe neutropenia in a patient treated with multiple coronary stents and provide suggestions for an alternative treatment.
阿司匹林联合噻吩吡啶类药物的双重抗血小板治疗已成为接受冠状动脉支架置入术患者的标准治疗方法。由于氯吡格雷的不良事件谱更有利，它已基本取代了噻氯匹定的使用。然而，氯吡格雷的使用也并非没有副作用。氯吡格雷的主要不良事件表现为骨髓抑制，表现为再生障碍性贫血、血小板减少和中性粒细胞减少。当发生氯吡格雷毒性时，替代治疗方法很少且缺乏充分依据，因此在这些情况下，医疗决策可能非常困难。我们报告了一例在接受多个冠状动脉支架治疗的患者中氯吡格雷诱导的骨髓毒性表现为严重中性粒细胞减少的病例，并提供了替代治疗的建议。
