摘要
病例1:1例78岁女性患者,因脑梗死、心房颤动口服达比加群酯抗凝治疗,初始剂量110 mg,bid,治疗前凝血四项均正常。服药5 d后及其后多次复查凝血酶时间(TT)明显延长,最长147 s(正常上限21 s);活化部分凝血活酶时间(APTT)轻度延长或正常高限,凝血酶原时间(PT)、凝血酶原时间国际标准化比值(INR)、纤维蛋白原(FIB)正常,患者出现皮下出血。停药3 d后测TT、APTT正常,恢复服药后TT、APTT再度延长。达比加群酯减至55 mg,qd,TT延长缩短至62.2 s,APTT正常。病例2:1例71岁男性患者,因阵发性房颤口服达比加群酯150 mg,bid抗凝治疗。1个月后查PT 13.3 s略延长,APTT延长47.3 s,TT>60 s明显延长,INR、FIB正常。停用达比加群酯5 d后查PT、APTT、TT均正常。该2例患者均于口服达比加群酯后出现TT、APTT延长,且停药后均恢复正常,病例1提示TT、APTT延长程度与药物剂量有关,提示TT、APTT或许可以作为监测达比加群药物作用的指标,其结论仍需大规模的研究加以验证。
Case 1： One 78-year-old female patient took dabigatran etexilate 110 mg twice daily because of atrial fibrillation and cerebral infarction. The results of routine coagulation assays were normal before administration. Five days later, a remarkable prolongation of thrombin time （TT） and mild prolongation of activated partial thromboplastin time （APTT） were detected and continued for two months. The longest TT was 147 s （upper limit of normal is 21 s）. The indexes of prothrombin time （PT）, the international normalized ratio （INR） and fibrinogen （FIB） were normal. Subcutaneous hemorrhage also occurred. Three days after dabigatran etexilate discontinued, TT and APTT returned to normal. While the patient received dabigatran etexilate 110 mg once daily, TT and APTT prolonged again. After dabigatran etexilate reduced to 55 mg once daily, TT prolongation was shorten （62.2 s） and AFVr returned to normal. Case 2： One 71-year-old male patient with paroxysmal atrial fibrillation took dabigatran etexilate 150 mg twice daily. One month later, it was found that TT prolonged more than 60 s, APTI＂ prolonged to 47.3 s and PT slightly prolonged to 13.3 s. Five days after dabigatran etexilate discontinued, TT, APTT and PT returned to normal. TT and APTT prolongation induced by dabigatran etexilate were found in these two aged patients. Prolongation was found to be dose-dependent in case 1. These results suggested that TT and APTT may be applied for monitoring and evaluating the anticoagulant effects of dabigatran etexilate, the reliability of the conclusion still need to be verified by large scale study.
出处
《中国药物应用与监测》
CAS
2016年第1期58-61,共4页
Chinese Journal of Drug Application and Monitoring
关键词
达比加群酯
心房颤动
抗凝治疗
凝血酶时间
老年患者
药品不良反应
Dabigatran etexilate
Atrial fibrillation
Anticoagulant therapy
Thrombin time
Elderly patient
Adverse drug reaction
