Duke Regional Hospital, Durham, NC, USA.
Vidant Medical Center, NC, USA.
J Pharm Pract. 2020 Jun;33(3):378-381. doi: 10.1177/0897190018799186. Epub 2018 Sep 6.
To report a case of acquired hemophilia secondary to levofloxacin and provide a guide for the use of anticoagulation in acute coronary syndrome.
A 75-year-old female treated with levofloxacin presented with spontaneous bruising of the upper extremities. Levofloxacin was discontinued and the symptoms resolved. Thereafter, the spontaneous bruising recurred and progressed over a few weeks. The patient was treated with recombinant factor VIIA with a time to recuperation of 3 months. The patient was subsequently found to have ST-segment elevation for which they received unfractionated heparin, ticagrelor, and aspirin prior to bare metal stent placement.
Hemophilia A is a rare disease associated with high morbidity and mortality. Case studies previously evaluating the association of levofloxacin with acquired hemophilia have shown causality. Initiating anticoagulation in patients with acquired hemophilia has long been a challenge to clinicians as evidence-based guidelines are lacking and bleeding risk may outweigh the benefit of anticoagulation. Furthermore, factor VIII deficiency does not provide additive protection against atherosclerotic plaque formation. This case report supports existing literature associating levofloxacin with acquired hemophilia. Due to the complication of life-threatening bleeds, familiarity with the treatment course following coronary events will allow patients with acquired hemophilia to be adequately and safely anticoagulated.
报告 1 例左氧氟沙星继发获得性血友病病例，并为急性冠状动脉综合征患者的抗凝治疗提供指导。
1 例 75 岁女性因左氧氟沙星治疗而出现上肢自发性瘀斑，停用左氧氟沙星后症状缓解。此后，自发性瘀斑再次出现并逐渐加重，持续数周。给予重组 VIIa 因子治疗，恢复时间为 3 个月。随后患者因 ST 段抬高而接受未分级肝素、替格瑞洛和阿司匹林治疗，之后行金属裸支架置入术。
血友病 A 是一种罕见疾病，与高发病率和死亡率相关。既往评估左氧氟沙星与获得性血友病相关性的病例研究表明存在因果关系。由于缺乏循证指南，启动获得性血友病患者的抗凝治疗一直是临床医生面临的挑战，出血风险可能超过抗凝的益处。此外，VIII 因子缺乏并不能为动脉粥样硬化斑块形成提供额外的保护。本病例报告支持左氧氟沙星与获得性血友病相关的现有文献。由于致命性出血的并发症，熟悉冠状动脉事件后治疗过程将使获得性血友病患者能够得到充分和安全的抗凝治疗。
