病例報告：全身性硬化症在Rofecoxib使用後發生右肩鎖骨靜脈栓塞

Right Subclavian Vein Thrombosis Associated with Rofecoxib Treatment in a Patient with Progressive Systemic Sclerosis

全身性硬化症是一種自體免疫疾病，常有發生血栓靜脈炎的機會，但臨床上發生在中心靜脈如腋下及鎖骨下靜脈栓塞的機會卻很少。我們常見到硬皮症患者發生肢端缺血甚至壞死的情況，可能的原因一般認為和硬皮症本身血管內皮細胞受損或增生，或發生血管炎抑或是合併如抗磷脂抗體症候群等自體免疫疾病有關。本篇報告一位44歲硬皮症男性病患在使用Rofecoxib後，發生右肩鎖骨下靜脈栓塞的情形，爾後症狀在停藥及使用抗凝血藥劑之後緩解。儘管過去的大型臨床試驗未證實COX-2抑制劑的致栓塞性，但在文獻上有報告在使用COX-2抑制劑後發生血栓的病例，這些病例都有自體免疫疾病。因此，COX-2抑制劑對致血栓與抗血栓Eicosanoids所造成的不平衡影響，加上自體免疫疾病之病患常合併血管病變，可能更容易發生血管栓塞的情形。綜上，對於自體免疫疾病病患，在臨床上使用COX-2抑制劑時，必須特別注意及觀察。

Right subclavian vein thrombosis developed in a 44-year-old Chinese man with progressive systemic sclerosis after shift of treatment from sulindac to rofecoxib for one week. Progressive systemic sclerosis (PSS) tends to have vasculopathy, however, the incidence of major vessel thrombosis in PSS is rare. COX-2 specific inhibitors have improved GI safety, but concerns about their cardiovascular safety and prothrombotic effect have been raised. There have been six case reports of thrombosis in patients with connective tissue disease treated with COX-2 inhibitors. We propose that rofecoxib may exacerbate sclerodermatous vasculopathy and result in subclavian vein thrombosis in this case.