Life‐threatening haemorrhage after extracorporeal shockwave lithotripsy in a patient taking clopidogrel
Life‐threatening haemorrhage after extracorporeal shockwave lithotripsy in a patient taking clopidogrel
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服用氯吡格雷的患者在体外冲击波碎石术后出现危及生命的出血
作者：
G. Sare;F. R. Lloyd;M. Stower
一名53岁的男子提出了一个3周的历史，右腰疼痛，成为严重超过2天。他的病史包括两次心肌梗死，为此他被处方了各种心脏药物;由于他不耐受阿司匹林，这些药物包括氯吡格雷75 mg每日一次。IVU显示右侧输尿管结石。在输尿管镜检查过程中，结石很明显，尽管尝试粉碎和取石均未成功;结石被推回肾脏，JJ支架留在原位。输尿管镜检查后，患者出院回家，预约ESWL。出院时，患者的血红蛋白为148 g/L。16天后，患者到日间病房接受ESWL，进展顺利;治疗完成后2小时，患者出现不适，主诉右腰部疼痛，临床休克，BP为90/ 50 mmHg。患者入院并接受后续治疗。第二天早上，患者的血红蛋白水平为81 g/L，凝血功能正常（国际标准化比值1.1，活化部分凝血活酶时间30.6）。CT显示广泛的局限性肾周血肿（图1）。患者输了4个单位的血，6天后出院回家;他仍在等待结石治疗的完成。
A 53-year-old man presented with a 3-week history of right loin pain which became severe over 2 days. His medical history included two myocardial infarctions, for which he was prescribed a variety of cardiac medications; as he was intolerant of aspirin these included clopidogrel 75 mg once daily. IVU showed a right ureteric stone. During ureteroscopy a stone was apparent, although attempts at fragmentation and stone removal were unsuccessful; the stone was pushed back to the kidney and a JJ stent left in situ . After ureteroscopy the patient was discharged home with an appointment for ESWL. On discharge the patient’s haemoglobin was 148 g/L. The patient attended the day unit for ESWL 16 days later, which proceeded uneventfully; 2 h after completing the treatment the patient became unwell, complaining of pain in the right loin, and was clinically shocked with a BP of 90/ 50 mmHg. The patient was admitted and treated supportively. The following morning the patient had a haemoglobin level of 81 g/L with normal clotting (international normalized ratio 1.1, activated partial thromboplastin time 30.6). CT showed an extensive localized perinephric haematoma (Fig. 1). The patient was transfused with 4 units of blood and discharged home 6 days later; he is still awaiting completion of treatment for his stone.
氯吡格雷疗法的个性化方法：我们在那里吗？
影响因子：
8.3
作者：
Anderson CD;Biffi A;Greenberg SM;Rosand J
通讯作者：
Rosand J