관상동맥 성형술 시행한 환자에서 Clopidogrel과 관련된 용혈성 요독증후군
Hemolytic Uremic Syndrome with Clopidogrel after Coronary Angioplasty
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초록
Clopidogrel은 항혈소판제로 여러 임상영역에서 사용된다. 기존의 약제보다 부작용도 적어 안전하게 널리 쓸 수 있는 이 약제가 드물게는 이와 같은 심각한 합병증을 유발할 수 있다. 이에 우리는 이러한 합병증을 이해하고 주의 해야 한다. 저자들은 급성 관상동맥 증후군이 있었던 47세 남자 환자에서 이와 같은 합병증을 경험하였고, 약물 중단 및 치료적 혈장분리술 등으로 호전되었던 증례를 1예 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Thienopyridines are antiplatelet agents used in post-percutaneous coronary angioplasty patients and patients with acute coronary syndrome, stroke, and peripheral arterial disease. Ticlopidine has been shown to reduce the incidence of stent thrombosis, but it may also cause serious hematological side effects. Among the thienopyridines, clopidogrel is considered to be a safe alternative to ticlopidine because of its decreased incidence of hematological adverse effects. However, some hematological side effects can occur and may be fatal. In this case, a 47-year-old man complained of dyspnea and generalized edema. He had been taking clopidogrel after coronary angioplasty. His laboratory findings showed acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia, which were consistent with hemolytic uremic syndrome (HUS). After discontinuing clopidogrel and undergoing plasma exchange, he recovered fully. To our knowledge, this is the first reported case of clopidogrel-induced HUS in Korea. (Korean J Med 2011;80:S253-S257)
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