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1例66岁男性患者因心肌梗死入院,并立即行经皮冠状动脉腔内成形术及支架术。术后当日规律口服氯吡格雷75 mg,1次/d;阿司匹林首剂量300 mg,之后100 mg,1次/d;氟伐他汀20 mg,1次/d;福辛普利钠10 mg,1次/d。1个月后,患者出现寒战、高热。血常规检查:白细胞1.1×109/L,中性粒细胞0.034,中性粒细胞绝对值0.037×109/L,红细胞3.6×1012/L,血红蛋白113 g/L,血小板119×109/L。骨髓穿刺及活检示非重型再生障碍性贫血。给予对症治疗,血常规各项水平继续下降。入院第44天血常规检查:白细胞2.6×109/L,中性粒细胞0.367,中性粒细胞绝对值0.954×109/L,红细胞3.6×1012/L,血红蛋白113 g/L,血小板84×109/L。立即停用氯吡格雷及阿司匹林,改用华法林2.5 mg,1次/d口服,西洛他唑100 mg,2次/d口服,其他药物继续服用。随后血常规检查示全血细胞计数下降至最低值后逐渐上升。再行2次骨髓穿刺检查,结果示骨髓象逐渐恢复。入院第102天血常规检查:白细胞5.8×109/L,中性粒细胞0.552,中性粒细胞绝对值3.202×109/L,红细胞4.2×1012/L,血红蛋白140 g/L,血小板170×109/L。再次加用氯吡咯雷50 mg,1次/d;阿司匹林100 mg,1次/d。1周后血常规检查示全血细胞计数明显下降,2周后血常规检查:白细胞3.4×109/L,中性粒细胞0.349,中性粒细胞绝对值1.187×109/L,红细胞4.0×1012/L,血红蛋白133 g/L,血小板176×109/L。随后,仅停用氯吡咯雷,改为西洛他唑100 mg,3次/d口服。1周后血象恢复正常。
A 66-year-old man was admitted to hospital for myocardial infarction and underwent immediate percutaneous transluminal coronary angioplasty and stenting. Oral administration of clopidogrel 75 mg once daily on the day after surgery, aspirin first dose 300 mg, then 100 mg once daily, fluvastatin 20 mg once daily, fosinopril sodium 10 mg, 1 time / d. One month later, the patient developed chills and fever. Blood tests: white blood cells 1.1 × 109 / L, neutrophils 0.034, neutrophils absolute 0.037 × 109 / L, red blood cells 3.6 × 1012 / L, hemoglobin 113 g / L, platelets 119 × 109 / L. Bone marrow biopsy and biopsy showed non-severe aplastic anemia. Give symptomatic treatment, blood levels continue to decline in all levels. On the 44th day after admission, blood routine examination showed that leukocyte 2.6 × 109 / L, neutrophil 0.367, neutrophil absolute value 0.954 × 109 / L, erythrocyte 3.6 × 1012 / L, hemoglobin 113 g / L, platelet 84 × 109 / L. Immediate withdrawal of clopidogrel and aspirin, switch to warfarin 2.5 mg, 1 / d orally, cilostazol 100 mg, 2 times / d orally, and other drugs continue to take. Followed by blood tests showed that the total blood count dropped to a minimum and then gradually increased. Followed by 2 bone marrow biopsy, the results showed a gradual recovery of bone marrow. Blood routine examination on the 102th day of admission: white blood cells 5.8 × 109 / L, neutrophils 0.552, neutrophils absolute value 3.202 × 109 / L, red blood cells 4.2 × 1012 / L, hemoglobin 140 g / L, platelet 170 × 109 / L. Once again add chlorpyriride 50 mg, 1 / d; aspirin 100 mg, 1 time / d. One week later, blood routine examination showed that the number of whole blood cells decreased significantly. After 2 weeks’ blood tests, the number of leucocytes 3.4 × 109 / L, neutrophils 0.349, neutrophils absolute 1.187 × 109 / L, erythrocytes 4.0 × 1012 / L, hemoglobin 133 g / L, platelet 176 × 109 / L. Subsequently, only the use of clopidogrel was discontinued, replaced with cilostazol 100 mg, 3 times / d orally. 1 week after the blood returned to normal.