氯吡格雷和沙格雷酯联用致血小板减少

1例74岁女性患者行人工血管旁路移植术，术后给予肝素，约8．33U·Kg^-1·min^-1静脉泵入；氯吡格雷50mg，1次／d口服；沙格雷酯100mg，3次／d口服；华法林3mg／d口服。手术次日停用肝素，改为达肝素钠0．4ml，1次／12h皮下注射。术后第7天血小板301×10^9／L，停用达肝素钠，同时加用辛伐他汀20mg／d，氯吡格雷、沙格雷酯及华法林按原剂量口服。术后6个月停用华法林，继续口服其他3种药物，此时复查血小板计数为240×10^9／L。术后9个月复查，血小板计数降至1×10^9／L，白细胞及血红蛋白水平正常。立即停用氯吡格雷和沙格雷酯，继续口服辛伐他汀。停药4周，血小板计数恢复至156×10^9／L。

Thrombocytopenia associated with combined therapy with clopidogrel and sarpogrelate

A 74-year-old female patient underwent synthetic vascular bypass grafts and, after surgery, received an IV infusion of heparin 8.33 U · Kg^-1 · min-1 via pump, oral clopidogrel 50 nag once daily, sarpogrelate 100 mg thrice daily, and warfarin 3 nag/d. On the second day after surgery, heparin was withdrawn and switched to subcutaneous daheparin sodium 0.4 ml once every 12 hours. On day 7 after surgery, her platelet count was 301 × 10^9/L and daheparin sodium was stopped. Meanwhile, simvastatin 20 mg/d was added to the regimen and oral clopidogrel, sarpogrelate, and warfarin were given according to original dosage. At the sixth postoperative month, warfarin was discontinued and other three medications were continued. At that moment, reexamination showed a platelet count of 240 × 10^9/L. At the ninth postoperative month, retests revealed that the platelet count decreased to 1 × 10^9/L and the levels of white blood cell and hemoglobin were normal. Clopidogrel and sarpogrelate were withdrawn immediately and oral simvastatin was continued. At 4 weeks after discontinuation, her platelet count returned to 156 × 10^9/L.