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1例56岁男性急性心肌梗死患者规律口服阿司匹林和氯吡格雷2个月后接受冠状动脉造影及经皮冠状动脉介入治疗。术前血小板计数为185×10~9/L。术中给予普通肝素,支架植入后用微量注射泵以0.1μg/(kg·min)的速度持续静脉输注替罗非班36 h。输注替罗非班约12 h,患者双上肢出现散在瘀斑,血小板计数下降至5×10~9/L。立即停用替罗非班、阿司匹林和氯吡格雷,并给予地塞米松。术后第4天,恢复使用氯吡格雷。术后第5天,恢复阿司匹林。术后第6天,患者瘀斑消失,血小板计数恢复至正常水平。考虑患者出现重度血小板减少是替罗非班所致。
A 56-year-old male patient with acute myocardial infarction was treated with regular coronary aspirin and clopidogrel 2 months after coronary angiography and percutaneous coronary intervention. Preoperative platelet count was 185 × 10 ~ 9 / L. Unfractionated heparin was given intraoperatively, and the stent was infused with Tirofiban for 36 h at a rate of 0.1 μg / (kg · min) with a microinjection pump. Tirofiban infusion for about 12 h, patients with scattered upper limbs ecchymosis, platelet count decreased to 5 × 10 ~ 9 / L. Tirofiban, aspirin and clopidogrel were discontinued immediately and dexamethasone was given. On the fourth postoperative day, clopidogrel was resumed. On the 5th postoperative day, aspirin was recovered. On the 6th day after operation, the ecchymosis disappeared and the platelet count returned to normal. Tirofiban is considered due to severe thrombocytopenia in patients.