104例住院患者药源性血小板减少症不良反应报告分析

目的：探讨住院患者药源性血小板减少症的规律和特点，为临床用药安全提供参考。方法：收集我院2012年1月-2018年10月年上报至国家药品不良反应监测平台的不良反应为药源性血小板减少症的病例，统计分析患者性别、年龄、原患疾病、可疑药物、临床表现、血小板计数、转归等相关因素。结果：共收集药源性血小板减少症104例，上报者以药师为主导，男女比例为2.35：1；涉及药品13类，46种，以抗肿瘤药物导致的血小板减少最多，40例（38.46%）；排名前3位药物的分别为低分子量肝素注射液（13例）、盐酸替罗非班注射液（9例）和注射用头孢哌酮钠舒巴坦钠（9例）；药源性血小板减少症发生的时间主要集中在2~7 d，共59例（56.73%）；严重血小板减少患者（0 ≤ PLT ≤ 5×10⁹/L）共14例，其中以盐酸替罗非班注射液最多（4例）；当PLT ≤ 20×10⁹/L时，患者发生出血概率明显高于PLT>20×10⁹/L（P<0.05）。COPD和联用≥ 2种致DITP药物是导致血小板减少患者出血的独立危险因素；针对血小板减少，临床上仅停药处理的有45例，其次治疗药物选择重组人白介素-11（25例）和输注血小板（21例）较多。结论：导致血小板减少的药物较多，临床上在应用这些药物时，要密切关注患者临床表现和监测血小板计数，确保用药安全。

Analysis of 104 cases of adverse reaction of drug-induced thrombocytopenia in hospitalized patients

OBJECTIVE To investigate the regular pattern and characteristics of drug-induced thrombocytopenia, so as to provide reference for rational drug use in clinic practice. METHODS The cases of drug-induced thrombocytopenia reported to the National Adverse Drug Reaction Monitoring Platform from January 2012 to October 2018 in our hospital were collected. The gender, age, primary disease, suspected drug, clinical manifestation, platelet count, outcome and other related factors were analyzed statistically. RESULTS A total of 104 cases of drug-induced thrombocytopenia were collected. The majority of adverse drug reaction were reported by the pharmacists with a male to female ratio of 2.35:1. Thirteen types of drugs (46 categories) were involved, and 40 cases (38.46%) were caused by anti-tumor drugs. The top three drugs were low molecular weight heparin injection (13 cases), tirofiban hydrochloride injection (9 cases) and cefoperazone sodium sulbactam sodium (9 cases). The occurrence time of ADR was mainly within 2-7 days (59 cases, 56.73%). Among 14 cases with severe thrombocytopenia (0 ≤ PLT ≤ 5×10⁹/L), tirofiban hydrochloride injection was the leading cause (4 cases). The probability of bleeding in the patients with a PLT ≤ 20×10⁹/L were significantly higher tha nthose with a PLT>20×10⁹/L (P<0.05). COPD and the combination of ≥ 2 drugs which induced DITP were independent risk factors for bleeding in patients with thrombocytopenia; for thrombocytopenia, only 45 patients were discontinued clinically, followed by introduction of recombinant human interleukin-11 (25 patients) and platelet transfusions (21 patients).CONCLUSION A variety of drugs can cause drug-induced thrombocytopenia, so we should pay close attention to the clinical manifestation and monitor the platelet count in clinical application of these drugs to ensure the safety of medication.