目的系统评价癌症相关静脉血栓栓塞(VTE)患者使用新型口服抗凝剂(NOAC)的有效性和安全性。方法检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据库,检索时限为各数据库建库起至2023年8月,收集低分子肝素(LMWH...目的系统评价癌症相关静脉血栓栓塞(VTE)患者使用新型口服抗凝剂(NOAC)的有效性和安全性。方法检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据库,检索时限为各数据库建库起至2023年8月,收集低分子肝素(LMWH,对照组)对比NOAC(试验组)治疗癌症相关VTE患者疗效的随机对照试验(RCT),对纳入临床研究进行资料提取后,采用RevMan 5.0统计软件进行Meta分析。结果共计纳入7项RCT,合计3790例癌症相关VTE患者。与对照组相比,试验组患者的VTE复发率(RR=0.65,95%CI为0.51~0.82,P=0.0004)显著降低,而其大出血发生率略高于对照组,但差异无统计学意义(RR=1.13,95%CI为0.83~1.53,P=0.45)。试验组患者的临床相关非主要大出血(RR=1.69,95%CI为1.34~2.13,P<0.00001)、消化道出血(RR=1.96,95%CI为1.15~3.34,P=0.01)发生率均较对照组显著升高。两组患者颅内出血发生率、全因死亡率、致死性肺栓塞发生率比较,差异均无统计学意义(P>0.05)。结论对于癌症相关VTE患者,NOAC在预防VTE复发方面优于LMWH,在大出血、颅内出血、全因死亡、致死性肺栓塞方面不劣于LMWH。展开更多
目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝...目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.展开更多
文摘目的系统评价癌症相关静脉血栓栓塞(VTE)患者使用新型口服抗凝剂(NOAC)的有效性和安全性。方法检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据库,检索时限为各数据库建库起至2023年8月,收集低分子肝素(LMWH,对照组)对比NOAC(试验组)治疗癌症相关VTE患者疗效的随机对照试验(RCT),对纳入临床研究进行资料提取后,采用RevMan 5.0统计软件进行Meta分析。结果共计纳入7项RCT,合计3790例癌症相关VTE患者。与对照组相比,试验组患者的VTE复发率(RR=0.65,95%CI为0.51~0.82,P=0.0004)显著降低,而其大出血发生率略高于对照组,但差异无统计学意义(RR=1.13,95%CI为0.83~1.53,P=0.45)。试验组患者的临床相关非主要大出血(RR=1.69,95%CI为1.34~2.13,P<0.00001)、消化道出血(RR=1.96,95%CI为1.15~3.34,P=0.01)发生率均较对照组显著升高。两组患者颅内出血发生率、全因死亡率、致死性肺栓塞发生率比较,差异均无统计学意义(P>0.05)。结论对于癌症相关VTE患者,NOAC在预防VTE复发方面优于LMWH,在大出血、颅内出血、全因死亡、致死性肺栓塞方面不劣于LMWH。
文摘目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.
