老年达比加群所致急性肝损伤病例报告及文献复习

IF 0.4 Q4 GERONTOLOGY Journal of Gerontology and Geriatrics Pub Date : 2021-06-15 DOI:10.36150/2499-6564-n345
A. Calabrese, V. Calsolaro, R. Franchi, S. Rogani, D. Guarino, C. Okoye, F. Monzani
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引用次数: 0

摘要

目标。达比加群是一种凝血酶的直接抑制剂,是华法林的有效替代品。尽管达比加群具有良好的耐受性和可预测的药代动力学特征,但它可能与不良反应有关,包括胃肠道疾病。在这里,我们报告了一个肝毒性病例,并对达比加群引起的肝损伤的现有文献进行了广泛的修订。方法与结果。一位84岁的老人在感到疲劳几天后到急诊科就诊。他患有心房颤动,并在过去四周开始服用达比加群(110毫克/次)。临床检查显示心动过速,巩膜黄疸,无慢性肝病征象。血液化学显示肝功能改变:AST 809 IU/L, ALT 1629 IU/L,总胆红素2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L。对感染性、自身免疫性或代谢性肝毒性病理的实验室检查无显著差异。腹部超声检查排除血管原因,显示非均匀回声结构,符合轻度肝脂肪变性。在我们的老年病房入院时,停用达比加群,改用氟达哌啶。两周内肝炎消退,血液化学恢复正常。很少有病例描述了可能由最近开始使用达比加群治疗引起的肝毒性。结论。DOACs相关的肝毒性是罕见的,但有潜在的危害,应该记住,特别是在合并不明原因肝损伤的患者中。达比加群治疗期间肝损伤的机制尚不清楚,与细胞色素P450酶无关,因为药物不影响CYP450活性。
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Dabigatran-induced acute liver injury in older patients: case report and literature review
Objective. Dabigatran, a direct inhibitor of thrombin, represents an effective alternative to warfarin. Despite the good tolerance and predictable pharmacokinetic profile, dabigatran may be associated to adverse reactions, including gastrointestinal disorders. Here we report on a case of hepatotoxicity along with an extensive revision of the available literature on dabigatran induced liver injury.Methods & results. An 84 years old man attended the Emergency Department after experiencing fatigue for a few days. He suffered from atrial fibrillation and had been initiated on dabigatran (110 mg bid) in the last four weeks. Clinical examination revealed tachycardia, scleral icterus in the absence of signs of chronic hepatic disease. Blood chemistry showed altered liver function tests: AST 809 IU/L, ALT 1629 IU/L, total bilirubin 2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L. Screening laboratory investigations for infectious, autoimmune or metabolic hepatotoxic pathology were unremarkable. The abdominal ultrasound examination excluded vascular causes, revealing non-homogeneous echo-structure consistent with mild hepatic steatosis. At admission to our Geriatric ward dabigatran was discontinued and fondaparinux was introduced. Resolution of the hepatitis and normalization of blood chemistry was observed within two weeks. Few cases are described regarding hepatotoxicity likely caused by the recent onset of treatment with dabigatran. Conclusions. DOACs associated hepatotoxicity is rare but potentially harmful and should be kept in mind, especially in comorbid patients with unexplained liver injury. The mechanism of liver injury during dabigatran therapy is unknown and, not related to cytochrome P450 enzymes since the drug does not affect CYP450 activity.
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来源期刊
CiteScore
0.70
自引率
0.00%
发文量
31
期刊介绍: The Journal of Gerontology and Geriatrics (JGG) is the official journal of the Italian Society of Gerontology and Geriatrics (SIGG), which will be an international, interdisciplinary, peer-reviewed journal concerning frontiers and advances in the field of aging. The aim of the journal is to provide a forum for original research papers, reviews, clinical case reports, and commentaries on the most relevant areas pertaining to aging. JGG publishes relevant articles covering the full range of disciplines pertaining to aging. Appropriate areas include (but are not limited to) Physiology and Pathology of Aging, Biogerontology, Epidemiology, Clinical Geriatrics, Pharmacology, Ethics, Psychology, Sociology and Geriatric Nursing.
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