CAJ | 학술논문

急性冠状动脉综合征（ ACS）合并血小板减少症时明显增加患者住院期间出血率和病死率，同时影响ACS治疗。而血小板减少症人群仍有发生血栓事件的可能。血小板减少症患者发生ACS时，血小板计数＜30×109／L时出血概率增加，不宜应用抗血小板药物。当血小板＞30×109／L应用双联抗血小板药物治疗的同时应积极提高血小板治疗，评价出血风险，密切监测血小板变化。如果进行冠状动脉介入治疗建议裸支架治疗。 ACS患者治疗期间出现血小板减少症主要的原因是药物导致血小板减少，包括肝素、血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂、氯吡格雷等，但应及时诊断方能准确治疗，要与弥散性血管内凝血等进行鉴别。
급성관상동맥종합정（ ACS）합병혈소판감소증시명현증가환자주원기간출혈솔화병사솔，동시영향ACS치료。이혈소판감소증인군잉유발생혈전사건적가능。혈소판감소증환자발생ACS시，혈소판계수＜30×109／L시출혈개솔증가，불의응용항혈소판약물。당혈소판＞30×109／L응용쌍련항혈소판약물치료적동시응적겁제고혈소판치료，평개출혈풍험，밀절감측혈소판변화。여과진행관상동맥개입치료건의라지가치료。 ACS환자치료기간출현혈소판감소증주요적원인시약물도치혈소판감소，포괄간소、혈소판당단백Ⅱb／Ⅲa수체길항제、록필격뢰등，단응급시진단방능준학치료，요여미산성혈관내응혈등진행감별。
The patients with acute coronary syndrome ( ACS ) complicating with thrombocytopenia not only significantly increases the rate of bleeding and mortality during hospitalization but also influences the treatment of ACS.The patients with thrombocytopenia also have the risk of thrombotic event.Thrombocytopenia in patients with ACS should not be given dual antiplatelet medications if platelet count is below 30 ×109/L, because of increased risk of bleeding.When the platelet count is above 30 ×109/L,active platelet therapy should be given,with evaluation of bleeding risk and close monitoring of platelet count change at the same time.The bare metal stent is recommended if coronary stent implantation is needed.The drug induction is the main reason of thrombocytopenia during the treatment of ACS,including heparin, platelet GPⅡb/Ⅲa recep-tor antagonist,clopidogrel etc.,which should be accurately diagnosed for timely treatment,and differentiation from disseminated intravascular coagulation etc.is important.