氯氮平致肺栓塞3例

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3例患者(例1男,48岁;例2女,65岁;例3女,58岁)均因精神分裂症服用氯氮平治疗,日剂量分别为200 mg、175 mg和100 mg。例1在氯氮平治疗16年后发生下肢静脉血栓,给予溶栓治疗后好转。10年后患者出现活动后气促症状,且逐渐加重,经CT肺动脉造影(CTPA)诊断为双肺动脉栓塞,先后给予华法林和利伐沙班抗凝治疗。1年后患者出现心功能不全症状。诊断为慢性血栓栓塞性肺动脉高压[肺动脉收缩压86 mmHg(1 mmHg=0.133 kPa)]、慢性肺源性心脏病、心功能不全,给予华法林联合强心、利尿等对症治疗,3个月后呼吸困难明显减轻,肺动脉收缩压降至48 mmHg。例2在氯氮平治疗5年后发生肺栓塞,行溶栓治疗后给予口服华法林治疗,3年后自行停药。停药2年后肺栓塞再发,先后给予那屈肝素钙和华法林抗凝治疗。3个月后CTPA示肺栓塞基本消失。例3在氯氮平治疗2年后发现下肢静脉血栓,1年后发生肺栓塞,经抗凝、利尿等治疗后好转。3年后自行停用华法林,停药10个月后肺栓塞再发,给予低分子肝素钠桥接华法林治疗。3个月后CTPA示肺动脉血栓基本消失。“,”Three patients (patient 1, a 48-years-old male; patient 2, a 65-years-old female; patient 3, a 58-years-old female) received clozapine for schizophrenia at daily doses of 200 mg, 175 mg, and 100 mg, respectively. Patient 1 developed venous thrombosis of lower limbs after 16 years of clozapine treatment, which was improved after thrombolytic therapy. Ten years later, the patient developed shortness of breath after activity and the symptom gradually worsened. Bilateral pulmonary embolism was diagnosed by computed tomographic pulmonary angiography (CTPA), and warfarin and rivaroxaban were given successively for anticoagulation. One year later, the patient developed cardiac insufficiency. The patient was diagnosed as having chronic thromboembolic pulmonary hypertension (pulmonary artery systolic pressure was 86 mmHg), chronic cor pulmonale, and cardiac insufficiency. Warfarin combined with cardiac glycosides, diuretics, and other symptomatic treatments were given. After 3 months of treatments, his dyspnea was markedly relieved and the pulmonary systolic pressure was reduced to 48 mmHg. Patient 2 developed pulmonary embolism after 5 years of clozapine treatment. After thrombolytic therapy, he was given oral warfarin and the drug was discontinued by himself 3 years later. Pulmonary embolism recurred 2 years after the drug withdrawal. Nadroparin calcium and warfarin anticoagulation was given successively and 3 months later, CTPA showed that pulmonary embolism basically disappeared. Patient 3 developed lower-extremity venous thrombosis after 2 years of clozapine treatment, and pulmonary embolism occurred 1 year later, which was improved after anticoagulation, diuretics, and other treatments. Three years later, the patient stopped warfarin by herself, and 10 months later, her pulmonary embolism recurred. Low-molecular-weight heparin sodium as bridge therapy to warfarin was given. Three months later, CTPA showed that pulmonary artery thrombosis basically disappeared.
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