利伐沙班所致PLT计数和功能变化研究进展

doi:10.3969/j.issn.1673-8640.2024.05.016

摘要/Abstract

摘要：

血栓性疾病严重威胁着人类的生命健康。目前，临床治疗血栓性疾病以抑制凝血机制启动、阻断凝血酶活化为主要策略。利伐沙班作为一种新型口服抗凝药物，可以高效、准确地阻断血栓瀑布形成，具有靶向、低副作用、低出血风险的优势。随着利伐沙班的临床广泛使用，其对血小板（PLT）数量和功能的影响开始显现。文章就利伐沙班临床应用中引起的PLT计数和功能变化及其机制的相关研究进行综述，以期对用药期间患者凝血功能的合理评价提供参考。

关键词: 血小板计数, 血小板聚集, 血小板活化, P-选择素, 利伐沙班

Abstract:

Thrombotic disease seriously threatens human life and health，especially the normal function of cardiovascular and cerebrovascular diseases. The main strategy of treating thrombotic disease is to inhibit the initiation of coagulation mechanism and block thrombin activation. As a new oral anticoagulant，rivaroxaban can efficiently and accurately block thrombus waterfall formation，with targeting，low side effects and low bleeding risk，and it has been widely used in clinical practice recently. With the widespread clinical use of rivaroxaban，its effects on platelet（PLT） count and function begins to emerge. In this review，the changes in PLT count and function and the mechanism caused by rivaroxaban are summarized to facilitate the rational evaluation on the coagulation function of patients during medication.

Key words: Platelet count, Platelet aggregation, Platelet activation, P-selectin, Rivaroxaban

中图分类号:

R446.11

熊天慧, 柴可宁, 夏薇, 曲林琳. 利伐沙班所致PLT计数和功能变化研究进展[J]. 检验医学, 2024, 39(5): 504-509.

XIONG Tianhui, CHAI Kening, XIA Wei, QU Linlin. Research progress of rivaroxaban causing changes in platelet count and function[J]. Laboratory Medicine, 2024, 39(5): 504-509.

图/表 5

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参考文献	研究对象和用药方案	用药前PLT计数/（×10⁹/L）	用药后PLT计数/ （×10⁹/L）
[19]	1例服用利伐沙班的阵发性AF^①患者；10 mg·d^-1，连续服用21 d	168	37^*（7 d后）
[20]	60例腹部手术后服用利伐沙班患者；10 mg·d^-1，连续服用7 d	263.15±27.09	219.92±22.27^*（7 d后）
[21]	34例骨折手术后服用利伐沙班患者；10 mg·d^-1，连续服用5周	194.12±23.28	173.17±19.82^*（用药后）
[22]	24例股骨干骨折髓内钉固定术后服用利伐沙班患者；10 mg·d^-1，连续服用7 d	237.29±1.99	203.18±1.78^*（7 d后）

参考文献	研究对象和用药方案	用药前PLT计数/（×10⁹/L）	用药后PLT计数/ （×10⁹/L）
[19]	1例服用利伐沙班的阵发性AF^①患者；10 mg·d^-1，连续服用21 d	168	37^*（7 d后）
[20]	60例腹部手术后服用利伐沙班患者；10 mg·d^-1，连续服用7 d	263.15±27.09	219.92±22.27^*（7 d后）
[21]	34例骨折手术后服用利伐沙班患者；10 mg·d^-1，连续服用5周	194.12±23.28	173.17±19.82^*（用药后）
[22]	24例股骨干骨折髓内钉固定术后服用利伐沙班患者；10 mg·d^-1，连续服用7 d	237.29±1.99	203.18±1.78^*（7 d后）

参考文献	研究对象和用药方案	激活剂	用药前PAR^①/%	用药后 PAR^①/%
[26]	21例服用利伐沙班的NVAF患者；15 mg·qd^-1，连续服用≥18 d	TRAP	56.15	8.53^*（7 d后）
[27]	14例服用利伐沙班的NVAF患者；15 mg·qd^-1或20 mg·qd^-1，连续服用≥7 d	凝血酶	69.55±32.15	44.79±34.97^*（7 d后）
[28]	6名健康志愿者，与递增浓度的利伐沙班混合	TF	78.00±5.00	77.50±1.60^*体外试验

参考文献	研究对象和用药方案	激活剂	用药前PAR^①/%	用药后 PAR^①/%
[26]	21例服用利伐沙班的NVAF患者；15 mg·qd^-1，连续服用≥18 d	TRAP	56.15	8.53^*（7 d后）
[27]	14例服用利伐沙班的NVAF患者；15 mg·qd^-1或20 mg·qd^-1，连续服用≥7 d	凝血酶	69.55±32.15	44.79±34.97^*（7 d后）
[28]	6名健康志愿者，与递增浓度的利伐沙班混合	TF	78.00±5.00	77.50±1.60^*体外试验

参考文献	研究对象	CD62P		PAC-1/（ng·L^-1）
参考文献	研究对象	用药前	用药后	用药前	用药后
[39]	100例服用利伐沙班的NVAF患者，15 mg·d^-1 50例，20 mg·d^-1 50例	（43.4±2.1）ng·L^-1 （43.8±2.0）ng·L^-1	（23.6±3.1）ng·L^-1* （31.7±2.8）ng·L^-1*
[40]	60例服用利伐沙班的DVT患者	（1.95±0.27）μmol·L^-1	（0.85±0.13）μmol·L^-1*
[41]	41例服用利伐沙班的DVT患者	（1.96±0.29）ng·L^-1	（0.88±0.13）ng·L^-1*
[42]	21例服用利伐沙班的VTE患者	（24.6±6.7）ng·L^-1	（21.8±8.6）ng·L^-1
[43]	21例服用利伐沙班20 mg·qd^-1超过6周的AF患者	（161.2±51.8）ng·mL^-1	（155.8±71.6）ng·L^-1
[16]	89例服用利伐沙班5 mg·bid^-1的2型糖尿病患者	（109.8±37）ng·L^-1	（102.9±37）ng·L^-1*
[17]	18例服用利伐沙班15或20 mg·qd^-1的NVAF患者	（40.05±18.06）ng·L^-1	（32.81±15.87）ng·L^-1*	16.16±13.79	10.38±8.35^*