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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8.33 U.Kg-1.min-1静脉泵入;氯吡格雷50 mg,1次/d口服;沙格雷酯100 mg,3次/d口服;华法林3 mg/d口服。手术次日停用肝素,改为达肝素钠0.4 ml,1次/12 h皮下注射。术后第7天血小板301×109/L,停用达肝素钠,同时加用辛伐他汀20 mg/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240×109/L。术后9个月复查,血小板计数降至1×109/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156×109/L。
A 74-year-old female patient underwent artificial blood-vessel bypass grafting. Heparin was administered after the procedure and was intravenously injected at about 8.33 U.Kg-1.min-1. Clopidogrel 50 mg once daily was administered orally. mg, 3 times / d orally; warfarin 3 mg / d orally. Heparin was discontinued the next day surgery, dalteparin 0.4 ml, 1/12 h subcutaneous injection. After the first 7 days of platelets 301 × 109 / L, dalteparin sodium deactivation, while adding simvastatin 20 mg / d, clopidogrel, sarpogrelate and warfarin according to the original dose of oral. Warfarin was discontinued at 6 months after operation and the other 3 drugs were orally administered. The platelet count at this time was 240 × 109 / L. Nine months after the review, platelet count decreased to 1 × 109 / L, normal white blood cells and hemoglobin levels. Stop taking clopidogrel and sarpogrel immediately and continue with simvastatin. Drug withdrawal for 4 weeks, platelet count recovered to 156 × 109 / L.