Hemodynamics and Epoprostenol Use Are Associated With Thrombocytopenia in Pulmonary Arterial Hypertension
Hemodynamics and Epoprostenol Use Are Associated With Thrombocytopenia in Pulmonary Arterial Hypertension
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DOI：
10.1378/chest.08-1323
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发表时间：
2009-01-01
期刊：
影响因子：
9.6
通讯作者：
Rubin, Lewis J.
中科院分区：
文献类型：
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作者：
Chin, Kelly M.;Channick, Richard N.;Rubin, Lewis J.
背景：某些晚期肺动脉高压（PAH）患者在接受依前列醇IV治疗时发生血小板减少。在本研究中，我们评估依前列醇的使用、其他PAR药物的使用、血流动力学或PAR病因是否与PAR患者的血小板减少症相关。方法：在一项横断面研究中，对47例接受IV治疗的PAR患者进行了血小板计数评估，这些患者对口服药物的初始治疗反应不足。血小板减少症（血小板计数<150，000/mL）与前列环素使用、血流动力学、PAR病因学和其他PAR药物使用之间的关系在单变量和多变量分析中进行了评估。结果：PAR亚型包括特发性（69%）、芬氟拉明（18%）、结缔组织病（10%）和先天性心脏病（2%）相关PAH。在34%接受依前列醇治疗的患者中观察到血小板减少，而接受口服治疗的患者为15%（比值比[OR]，2.9; p < 0.05），在校正血流动力学差异后，依前列醇与血小板减少之间的相关性仍然显著（OR，5.0; p < 0.05）。在单变量分析中，右心房压力（OR，1.12/mmHg; p < 0.05）和混合静脉血氧饱和度（Svo（2））[OR，0.92/百分比; p < 0.05]也与血小板减少症相关;在logistic回归分析后，使用依前列醇和Svo（2）与血小板减少症独立相关。在一个单独的分析，包括目前或以前使用依前列醇的患者，依前列醇剂量和右心房压力呈负相关与血小板count.Conclusion：依前列醇的使用和严重程度的血流动力学异常与血小板减少症的PAR，这些影响似乎是独立的和附加的。（CHEST 2009; 135：130-136）
Background: Thrombocytopenia develops in some patients with advanced pulmonary arterial hypertension (PAH) while receiving IV epoprostenol therapy. In this study, we evaluate whether epoprostenol use, other PAR medication use, hemodynamics, or PAR etiology are associated with thrombocytopenia in PAR. epoprostenol, and in PAH.Methods: Platelet counts were evaluated in 47 PAR patients receiving IV patients with an inadequate response to initial therapy with oral agents in a cross-sectional study. Associations between thrombocytopenia (platelet count < 150,000/mL) and epoprostenol use, hemodynamics, PAR etiology, and use of other PAR medications were evaluated in univariable and multivariable analyses.Results: PAR subtypes included idiopathic (69%), fenfluramine (18%), connective tissue disease (10%), and congenital heart disease (2%)-associated PAH. Thrombocytopenia was observed in 34% of patients treated with epoprostenol, compared with 15% of patients receiving oral therapy, (odds ratio [OR], 2.9; p < 0.05), and the association between epoprostenol and thrombocytopenia remained significant after adjustment for differences in hemodynamics (OR, 5.0; p < 0.05). Right atrial pressure (OR, 1.12 per nun Hg; p < 0.05) and mixed venous oxygen saturation (Svo(2)) [OR, 0.92 per percentage; p < 0.05] were also associated with thrombocytopenia in univariable analyses; after logistic regression analysis, both the use of epoprostenol and Svo(2) were independently associated with thrombocytopenia. In a separate analysis including only patients with current or prior epoprostenol use, epoprostenol dose and right atrial pressure were inversely associated with platelet count.Conclusion: Epoprostenol use and severity of hemodynamic abnormalities are associated with thrombocytopenia in PAR, and these effects appear to be independent and additive. (CHEST 2009; 135:130-136)