Kim Ji Hyun, Baek Chung Hee, Min Ji Yeon, Kim Joon-Seok, Kim Soon Bae, Kim Hyosang
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Ann Hematol. 2015 Sep;94(9):1457-61. doi: 10.1007/s00277-015-2384-1. Epub 2015 May 3.
Uremia is associated with platelet dysfunction and can cause a bleeding tendency resulting in a major bleeding event after an invasive procedure or surgery that may be aggravated by antiplatelet agents. We prospectively investigated the potential of desmopressin to improve platelet dysfunction and to lower bleeding risk after emergent invasive procedures in uremic patients taking antiplatelet drugs. Twenty-three patients were enrolled with a mean age of 60.2 ± 11.7 years. Baseline blood urea nitrogen and creatinine were 70.5 ± 29.4 and 10.02 ± 4.52 mg/dL, respectively. Twenty-one patients took aspirin. All patients were infused with desmopressin before their invasive procedures, which were a central catheter insertion for emergent hemodialysis in 13 patients, percutaneous nephrostomy in 7 patients, and angiography through arm or leg vessels in 3 patients. After desmopressin infusion, both the hematocrit and platelet count were slightly decreased without changes in prothrombin time or activated partial thrombin time. Collagen/epinephrine-closure time was significantly shortened from 252.7 ± 40.7 to 144.6 ± 51.0 s (p < 0.001). There were minimal bleeding in 20 patients and mild bleeding in 3 patients. None experienced severe bleeding event or required additional intervention for bleeding control. There were no adverse events including the decrease of serum sodium concentration. In conclusion, a single infusion of desmopressin before invasive procedures in uremic patients on antiplatelet drugs appeared to be well tolerated and improved platelet dysfunction measured by collagen/epinephrine-closure time.
尿毒症与血小板功能障碍相关，可导致出血倾向，在侵入性操作或手术后引发严重出血事件，而抗血小板药物可能会加重这种情况。我们前瞻性地研究了去氨加压素改善血小板功能障碍以及降低服用抗血小板药物的尿毒症患者在紧急侵入性操作后出血风险的潜力。纳入了23例患者，平均年龄为60.2±11.7岁。基线血尿素氮和肌酐分别为70.5±29.4和10.02±4.52mg/dL。21例患者服用阿司匹林。所有患者在侵入性操作前均输注了去氨加压素，其中13例患者为紧急血液透析进行中心静脉导管插入术，7例患者为经皮肾造瘘术，3例患者为通过手臂或腿部血管进行血管造影。输注去氨加压素后，血细胞比容和血小板计数均略有下降，凝血酶原时间或活化部分凝血活酶时间无变化。胶原/肾上腺素闭合时间从252.7±40.7秒显著缩短至144.6±51.0秒（p<0.001）。20例患者有轻微出血，3例患者有轻度出血。无患者发生严重出血事件或需要额外干预来控制出血。未出现包括血清钠浓度降低在内的不良事件。总之，在服用抗血小板药物的尿毒症患者进行侵入性操作前单次输注去氨加压素似乎耐受性良好，并通过胶原/肾上腺素闭合时间测量改善了血小板功能障碍。
