Pan Yannan, Liu Bing, Liu Junmeng, Zhuang Wei, He Qing, Lan Ming
School of Medicine, Peking University Health Science Center, Beijing, China.
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China.
BMC Cardiovasc Disord. 2022 Feb 11;22(1):40. doi: 10.1186/s12872-022-02490-3.
Clopidogrel is a widely-used antiplatelet and acts as an adenosine diphosphate receptor inhibitor. Neutropenia is a rare but serious adverse effect of clopidogrel. It is unknown whether this adverse effect has any association with impaired kidney function.
An 80-year-old male with chronic kidney disease was diagnosed with non-ST elevation myocardial infarction and underwent percutaneous coronary intervention. During hospitalization, the patient was diagnosed with contrast-induced nephropathy, treated symptomatically, and discharged with a back-to-baseline creatinine level. Two weeks later, the patient presented to the emergency department with fever and chills. Complete blood count showed leukopenia (0.84 × 10/mm) and severe neutropenia (0.13 × 10/mm). Blood cultures were positive for Pseudomonas aeruginosa. Clopidogrel was stopped immediately and switched into ticagrelor. Imipenem and granulocyte colony-stimulating factor were administered to the patient. The patient's white blood cell and absolute neutrophil count were within the normal range after four days of treatment. The patient was discharged after a 10-day hospitalization, and his complete blood counts were normal during further follow-ups.
Clopidogrel was the most likely primary cause of neutropenia in our case. The incidence of clopidogrel-induced neutropenia is low and the exact mechanism is not fully explained. We provide suggestions on the management of clopidogrel-associated neutropenia, and summarize all five cases of clopidogrel-induced neutropenia in patients with impaired kidney function.
氯吡格雷是一种广泛使用的抗血小板药物,作为一种二磷酸腺苷受体抑制剂发挥作用。中性粒细胞减少是氯吡格雷罕见但严重的不良反应。尚不清楚这种不良反应是否与肾功能损害有关。
一名患有慢性肾脏病的80岁男性被诊断为非ST段抬高型心肌梗死,并接受了经皮冠状动脉介入治疗。住院期间,该患者被诊断为造影剂肾病,接受了对症治疗,出院时肌酐水平恢复至基线。两周后,患者因发热和寒战就诊于急诊科。全血细胞计数显示白细胞减少(0.84×10⁹/L)和严重中性粒细胞减少(0.13×10⁹/L)。血培养铜绿假单胞菌阳性。立即停用氯吡格雷并换用替格瑞洛。给予患者亚胺培南和粒细胞集落刺激因子。治疗4天后患者的白细胞和绝对中性粒细胞计数恢复正常。住院10天后患者出院,进一步随访期间其全血细胞计数均正常。
在我们的病例中,氯吡格雷最有可能是中性粒细胞减少的主要原因。氯吡格雷诱导的中性粒细胞减少发生率较低,确切机制尚未完全阐明。我们对氯吡格雷相关性中性粒细胞减少的管理提出了建议,并总结了所有5例肾功能受损患者中氯吡格雷诱导的中性粒细胞减少病例。