Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USA.
Thromb Res. 2012 Sep;130(3):e26-30. doi: 10.1016/j.thromres.2012.05.017. Epub 2012 Jun 8.
Hemolytic uremic syndrome is a thrombotic microangiopathy. Clopidogrel, a recently developed platelet aggregation inhibitor, has not been previously reported as a treatment for this illness. Our study's objective was to explore the efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome.
We performed a retrospective chart review of all children (≤ 18 years) hospitalized with diarrhea associated hemolytic uremic syndrome. Outcomes in clopidogrel treated children were described. In subgroup analysis, outcomes were compared to those untreated with platelet aggregation inhibitors.
Of 72 children with diarrhea associated hemolytic uremic syndrome, 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%). The median age of clopidogrel treated children was 5 years; 40% were male. Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53 × 10(3)/μL, and 2.3mg/dL respectively. Clopidogrel (median dose 1mg/kg/d) was given for a median of 4 days (range 1-15). Other therapies included erythropoietin (98%), red blood cell transfusions (80%), diuretics (58%), anti-hypertensive agents (45%), and dialysis (33%). The median hospital length of stay was 9 days (range 3-26). Three children had bleeding complications (epistaxis/hematemesis). The risk of chronic kidney disease was 5% and death 2.5%. In subgroup analysis, median duration of dialysis was 11 days in thirteen clopidogrel treated children compared to 21 days in five untreated patients (P=0.04).
Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.
溶血尿毒综合征是一种血栓性微血管病。氯吡格雷是一种新开发的血小板聚集抑制剂，以前并未被报道用于治疗这种疾病。我们的研究目的是探讨氯吡格雷治疗腹泻相关溶血尿毒综合征患儿的疗效和安全性。
我们对所有（≤ 18 岁）因腹泻相关溶血尿毒综合征住院的患儿进行了回顾性图表审查。描述了接受氯吡格雷治疗的患儿的结局。在亚组分析中，将结果与未接受血小板聚集抑制剂治疗的患儿进行比较。
在 72 例腹泻相关溶血尿毒综合征患儿中，88%接受了血小板聚集抑制剂治疗（氯吡格雷 56%，磺吡酮 19%，双嘧达莫 13%）。接受氯吡格雷治疗的患儿的中位年龄为 5 岁；40%为男性。初始中位血红蛋白、血小板计数和血清肌酐分别为 10.1g/dL、53×10(3)/μL 和 2.3mg/dL。氯吡格雷（中位剂量 1mg/kg/d）的中位给药时间为 4 天（范围 1-15 天）。其他治疗包括促红细胞生成素（98%）、红细胞输注（80%）、利尿剂（58%）、抗高血压药物（45%）和透析（33%）。中位住院时间为 9 天（范围 3-26 天）。3 名患儿发生出血并发症（鼻出血/呕血）。慢性肾脏病的风险为 5%，死亡率为 2.5%。在亚组分析中，13 名接受氯吡格雷治疗的患儿的中位透析时间为 11 天，而 5 名未接受治疗的患儿为 21 天（P=0.04）。
接受氯吡格雷治疗的腹泻相关溶血尿毒综合征患儿的结局与未接受治疗的患儿相似。可能会发生出血并发症。
