Godier Anne, Dupont Mélanie, Desilles Jean-Philippe, Le Guerinel Caroline, Taylor Guillaume, Perrin Mathilde, Martin Anne-Céline, Gaussem Pascale
Service d'Anesthésie-Réanimation, Fondation Adolphe de Rothschild, Paris, France.
Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France.
TH Open. 2018 Sep 27;2(3):e346-e349. doi: 10.1055/s-0038-1672211. eCollection 2018 Jul.
Management of ticagrelor-associated bleeding is challenging, especially in neurosurgery. Platelet transfusion is inefficient and no antidote is currently available. We report here the first case of recombinant activated factor VII (rFVIIa) use to bypass ticagrelor-induced platelet inhibition. A woman treated with ticagrelor and requiring emergent neurosurgery for an intracranial hematoma received preoperative high-dose platelet transfusion and 60 μg/kg rFVIIa. Laboratory monitoring demonstrated that platelet transfusion failed to reverse ticagrelor-induced platelet inhibition while rFVIIa improved hemostasis by shortening the thromboelastometric clotting time. Neurosurgery occurred without any bleeding event but the patient presented with a postoperative pulmonary embolism. In conclusion, rFVIIa may decrease ticagrelor-induced bleeding risk but careful assessment of the benefit-risk balance is warranted before using rFVIIa to reverse ticagrelor effects.
替格瑞洛相关出血的管理具有挑战性，尤其是在神经外科手术中。血小板输注效率低下，目前尚无解毒剂。我们在此报告首例使用重组活化因子VII（rFVIIa）绕过替格瑞洛诱导的血小板抑制的病例。一名接受替格瑞洛治疗且因颅内血肿需要紧急神经外科手术的女性患者，术前接受了大剂量血小板输注和60μg/kg的rFVIIa。实验室监测表明，血小板输注未能逆转替格瑞洛诱导的血小板抑制，而rFVIIa通过缩短血栓弹力图凝血时间改善了止血效果。神经外科手术未发生任何出血事件，但患者术后出现了肺栓塞。总之，rFVIIa可能会降低替格瑞洛引起的出血风险，但在使用rFVIIa逆转替格瑞洛的作用之前，有必要仔细评估其利弊平衡。
