Department of Medicine, Marshfield Clinic Health System, Rice Lake, Wisconsin.
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2021 Nov;74(11):502-505.
Anagrelide is a drug used for treatment of essential thrombocytosis especially when conventional therapy is insufficient. Adverse effects associated with anagrelide are palpitation, liver toxicity, renal failure and in few cases pericardial effusion. We here report a rare case of anagrelide induced pericardial effusion.
A 76-year-old male with past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and myeloproliferative disorder presented to the emergency department with dyspnea on rest and exertion. He was initially treated with hydroxyurea for thrombocytosis but was later switched to anagrelide. On examination patient had muffled heart sounds. Lab investigations identified hyperkalemia and transaminitis. Transthoracic echocardiogram identified a moderate sized pericardial effusion. The pericardial effusion and transaminitis were attributed to anagrelide toxicity as other causes were ruled out. Pericardiocentesis was performed and anagrelide was discontinued. Patient was discharged in a well-compensated state with outpatient follow-up in two to three weeks.
Anagrelide is considered to be very effective treatment for essential thrombocytosis. It is, however, associated with serious adverse effects such as pericardial effusion, liver toxicity and palpitations. The mechanisms of these adverse drug reactions are still not completely understood. We suggest that patient taking anagrelide presenting with shortness of breath should have a transthoracic echocardiogram performed to rule out pericardial effusion. Liver enzymes should also be monitored closely and anagrelide discontinued immediately if the above-mentioned adverse events are noted.
氨肽素是一种用于治疗特发性血小板增多症的药物，尤其适用于常规治疗无效的情况。氨肽素相关的不良反应有心悸、肝毒性、肾衰竭，极少数情况下还会出现心包积液。我们在此报告一例罕见的氨肽素引起的心包积液病例。
一名 76 岁男性，既往有高血压、高血脂、慢性阻塞性肺疾病和骨髓增生性疾病病史，因休息和活动时呼吸困难就诊于急诊科。他最初因血小板增多症接受羟基脲治疗，但后来改用氨肽素。体格检查发现心音减弱。实验室检查发现高钾血症和转氨基酶升高。经胸超声心动图发现中等量心包积液。心包积液和转氨基酶升高归因于氨肽素毒性，因为已排除其他原因。进行了心包穿刺术，并停用了氨肽素。患者在代偿良好的情况下出院，并在 2 至 3 周后进行门诊随访。
氨肽素被认为是治疗特发性血小板增多症的非常有效的药物。然而，它与严重的不良反应有关，如心包积液、肝毒性和心悸。这些药物不良反应的机制仍不完全清楚。我们建议，服用氨肽素的患者出现呼吸困难时，应进行经胸超声心动图检查以排除心包积液。如果出现上述不良反应，应密切监测肝酶，并立即停用氨肽素。
