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口服抗凝药物致严重皮肤不良反应的文献分析
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| 篇名： | 口服抗凝药物致严重皮肤不良反应的文献分析 |
| TITLE： | Literature analysis of severe cutaneous adverse reactions induced by oral anticoagulants |
| 摘要： | 目的 分析口服抗凝药物（OACs）致严重皮肤不良反应（SCARs）的临床特征，为该类药物的临床安全应用提供参考。方法以“口服抗凝药“”Ⅹa因子抑制剂“”直接凝血酶抑制剂“”oralanticoagulants“”factorⅩainhibitor“”directthrombininhibitor”等为中英文检索词，计算机检索PubMed、Embase、中国知网、万方数据、维普网等数据库，收集OACs（华法林、阿哌沙班、利伐沙班、艾多沙班、达比加群酯）致SCARs的病例报道并进行描述性分析。结果共纳入11篇文献，共计11例患者，其中男性5例（45.5%）、女性6例（54.5%），平均年龄（59.6±21.5）岁；原患疾病主要为心房纤颤、肺栓塞、关节置换和瓣膜置换；涉及药物包括华法林（3例）、利伐沙班（4例）、阿哌沙班（2例）、达比加群酯（2例）。OACs致SCARs发生在用药后10h～42d，其中发生在用药后10～28d的有7例（63.6%）。11例患者中，5例为伴嗜酸性粒细胞增多和系统症状的药物反应，4例为史-约综合征或中毒性表皮坏死松解症，2例为急性泛发性发疹性脓疱病；临床表现包括皮疹、发热、黏膜受损等。除1例患者因败血症和弥散性血管内凝血死亡外，其余患者经停药、予糖皮质激素等对症治疗后好转或痊愈。结论SCARs是OACs罕见且严重的不良反应，多发生在用药后的10～28d；一旦怀疑为OACs所致SCARs，临床应及时停药并根据SCARs类型制定治疗方案，以保障患者的用药安全。 |
| ABSTRACT： | OBJECTIVE To analyze the characteristics of severe cutaneous adverse reactions （SCARs） induced by oral anticoagulants （OACs）， and provide a reference for clinical safety of drug use. METHODS Case reports of SCARs caused by OACs （warfarin， apixaban， rivaroxaban， edoxaban， dabigatran etexilate） were retrieved from PubMed， Embase， CNKI， Wanfang Data， VIP and other databases with search terms as “oral anticoagulants”“factor Ⅹa inhibitor”“direct thrombin inhibitor” and their Chinese equivalents. A descriptive statistical analysis was performed. RESULTS A total of 11 articles were included， involving 11 patients in total， among whom there were 5 males （45.5%） and 6 females （54.5%）， with an average age of （59.6±21.5） years. The primary underlying diseases were mainly atrial fibrillation， pulmonary embolism， joint replacement and valve replacement. The OACs involved included warfarin in 3 cases， rivaroxaban in 4 cases， apixaban in 2 cases， and dabigatran etexilate in 2 cases. SCARs occurred from 10 hours to 42 days after treatment， and 7 cases （63.6%） within 10 to 28 days. Among 11 patients， 5 cases were diagnosed as drug reaction with eosinophilia and systemic symptoms， 4 cases were diagnosed as Stevens-Johnson syndrome or toxic epidermal necrolysis， and 2 cases were diagnosed as acute generalized exanthematous pustulosis. The clinical manifestations mainly included rash， fever and mucosal damage， etc. Except for 1 patient who died of sepsis and diffuse intravascular coagulation， the rest of the patients improved or recovered after withdrawal and treatment with glucocorticoids. CONCLUSIONS SCARs are rare but serious adverse reactions caused by OACs， typically occurring 10 to 28 days after medication. Once SCARs are suspected to be caused by OACs， the medication should be discontinued immediately， and a treatment plan should be formulated based on the type of SCARs to ensure the safety of patients’ drug use. |
| 期刊： | 2025年第36卷第12期 |
| 作者： | 郑爽；姜荣荣；朱建国；谢诚 |
| AUTHORS： | ZHENG Shuang，JIANG Rongrong，ZHU Jianguo，XIE Cheng |
| 关键字： | 口服抗凝药；严重皮肤不良反应；史-约综合征；中毒性表皮坏死松解症；伴嗜酸性粒细胞增多和系统症状的药物反应；急 |
| KEYWORDS： | oral anticoagulants； severe cutaneous adverse reactions； Stevens-Johnson syndrome； toxic epidermal necrolysis； |
| 阅读数： | 4 次 |
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