| アブストラクト | The sulfhydryl group of clopidogrel metabolite could induce insulin autoimmune syndrome (IAS) with hypoglycemia as the major symptom. For patients with cardiovascular disease taking clopidogrel for vascular protection, this adverse event hypoglycemia increases the risk of cardiovascular events. However, discontinuing clopidogrel leaves patients without appropriate antiplatelet therapy. Treating IAS with glucocorticoids is also risky for these patients' primary cardiovascular diseases. Early recognition and appropriate treatment of clopidogrel-induced IAS (CIAS) would be beneficial for patients. This research aimed to discover the clinical features and investigate optimal therapeutic management of CIAS. We systematically searched for cases of CIAS in PubMed and Embase and performed data mining in Food and Drug Administration Adverse Event Reporting System (FAERS). In the CIAS series, clinical features were summarized and compared to 287 IAS cases, including demographic information, HLA alleles, onset, and symptoms. The therapeutic effect of glucocorticoids was compared between the receiving group and the not-receiving group. The possibilities of common antiplatelet drugs to induce hypoglycemia/IAS were investigated with chemical structure and FAERS reports. A CIAS series of 51 patients was established. CIAS had an onset age of 74.8+/-8.6 years old, 92.2% male, and a balanced proportion of East Asians and non-East Asians. Confusion occurred more frequently in CIAS than in IAS from various causes, while the other symptoms and hypoglycemia types were similar. The recovery time was approximately the same whether using glucocorticoids/immunotherapy in CIAS or not. Among common antiplatelet drugs, ticagrelor and rivaroxaban were unlikely to induce hypoglycemia/IAS. Clopidogrel is a distinctive cause of IAS featuring an elderly male presenting confusion as the symptom of hypoglycemia. Glucocorticoids/immunotherapy might not be necessary for the long-term recovery of CIAS. To balance the risks of hypoglycemia and cardiovascular events, substituting clopidogrel with ticagrelor and rivaroxaban might be considered. |
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| 投稿者 | Chen, Shi; Qiang, Jiaqi; Zhao, Bin; Tian, Ran; Yuan, Tao; Li, Ming; Li, Mei; Gu, Zhaoqi; Yang, Liping; Zhu, Huijuan; Pan, Hui; Tang, Yan; Li, Yuxiu |
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| 組織名 | Key Laboratory of Endocrinology of National Health Commission, Department of;Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical;Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of;China.;Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences and;Peking Union Medical College, Beijing, 100730, People's Republic of China.;Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of;Medical Sciences and Peking Union Medical College, Beijing, 100730, People's;Republic of China.;Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy;of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's;Department of Radiotherapy, Peking Union Medical College Hospital, Chinese;Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730,;People's Republic of China.;Department of Pharmacy, Handan First Hospital, Handan, Hebei Province, People's;State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical;College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical;College, Beijing, 100730, People's Republic of China. |
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