Department of Emergency Medicine, Division of Medical Toxicology, University of Southern California, Los Angeles, CA.
Department of Emergency Medicine, Division of Medical Toxicology, Carolinas Medical Center, Charlotte, NC.
Ann Emerg Med. 2018 Mar;71(3):273-278. doi: 10.1016/j.annemergmed.2017.08.046. Epub 2017 Oct 9.
In recent years, the use of novel anticoagulants and antiplatelet agents has become widespread. Little is known about the toxicity and bleeding risk of these agents after acute overdose. The primary objective of this study is to evaluate the relative risk of all bleeding and major bleeding in patients with acute overdose of novel antiplatelet and anticoagulant medications.
This study is a retrospective study of acute ingestion of apixaban, clopidogrel, ticlopidine, dabigatran, edoxaban, prasugrel, rivaroxaban, and ticagrelor reported to 7 poison control centers in 4 states during a 10-year span. The prevalence of bleeding for each agent was calculated, and hemorrhage was classified as trivial, minor, or major.
A total of 322 acute overdoses were identified, with the majority of cases involving clopidogrel (260; 80.7%). Hemorrhage occurred in 16 cases (4.9%), including 7 cases of clopidogrel, 6 cases of rivaroxaban, 2 cases of dabigatran, and 1 case of apixaban. Most cases of hemorrhage were classified as major (n=9). Comparing the novel anticoagulants with the P2Y12 receptor inhibitors, the relative risk for any bleeding with novel anticoagulant was 6.68 (95% confidence interval 2.63 to 17.1); the relative risk of major bleeding was 18.1 (95% confidence interval 3.85 to 85.0).
Acute overdose of novel anticoagulants or antiplatelet agents is associated with a small risk of significant hemorrhage. The risk is greater with the factor Xa inhibitors and direct thrombin inhibitors than with the P2Y12 receptor antagonists.
近年来，新型抗凝药和抗血小板药物的应用越来越广泛。关于这些药物急性过量使用后的毒性和出血风险知之甚少。本研究的主要目的是评估新型抗血小板和抗凝药物急性过量患者所有出血和大出血的相对风险。
这是一项回顾性研究，纳入了在 10 年间向 4 个州的 7 个中毒控制中心报告的 322 例急性服用阿哌沙班、氯吡格雷、噻氯匹定、达比加群、依度沙班、普拉格雷、利伐沙班和替格瑞洛的病例。计算了每种药物的出血发生率，并将出血分为轻微、中度和重度。
共发现 322 例急性药物过量，大多数病例涉及氯吡格雷（260 例，80.7%）。共发生 16 例出血（4.9%），包括 7 例氯吡格雷、6 例利伐沙班、2 例达比加群和 1 例阿哌沙班。大多数出血病例被归类为重度（n=9）。与 P2Y12 受体抑制剂相比，新型抗凝剂的任何出血相对风险为 6.68（95%置信区间 2.63 至 17.1）；大出血的相对风险为 18.1（95%置信区间 3.85 至 85.0）。
新型抗凝药或抗血小板药物急性过量与显著出血的风险较小相关。与 P2Y12 受体拮抗剂相比，Xa 因子抑制剂和直接凝血酶抑制剂的风险更高。
