华法林致鼻出血1例  

One case of nasal bleeding induced by warfarin

作　　者：兰艳纤[1] 韦美丹 LAN Yan-xian;WEI Mei-dan(Department of Pharmacy,Minzu Hospital of Guangxi Zhuang Autonomous Region/the Minzu Hospital of Guangxi Medical University,Nanning 530001,China;Department of Pharmacy,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510000,China)

机构地区：[1]广西壮族自治区民族医院药剂科/广西医科大学附属民族医院,广西南宁530001 [2]南方医科大学第三附属医院药剂科,广东广州510000

出　　处：《中国药物应用与监测》2018年第6期372-374,共3页Chinese Journal of Drug Application and Monitoring

基　　金：广东省医学科学技术研究基金项目(A2016499)

摘　　要：1例83岁男性患者,因急性肺栓塞给予华法林钠片(3 mg,qd)、低分子肝素钠注射液(5000 IU,q 12 h,iv)抗凝治疗,用药第3天,监测INR由1.06升至1.09;之后的3 d增加华法林剂量至4.5 mg·d^(-1)监测INR 2.16(达标)。当日,患者因右臀部疼痛予以骨科会诊考虑骨质疏松,给予依托考昔片(60 mg,bid)和复方塞隆胶囊(60 mg,bid)对症治疗,服药第3天患者出现一过性鼻出血,查INR 3.42,将华法林减量至3 mg·d^(-1)并停用依托考昔和复方塞隆胶囊,2 d后INR 4.34;给予停用华法林,6 d后INR降至2.21,重新服用华法林3 mg·d^(-1),予以出院。出院两周后随访,患者INR分别为2.16、2.03、2.20,未再出现鼻出血及其他出血迹象。A 83-year-old male patient with acute pulmonary embolism was given warfarin sodium tablets(3 mg,qd)and low molecular weight heparin sodium injection(5000 IU,q 12 h,iv).INR was increased from 1.06 to 1.09 three days later and the dose of warfarin was increased to 4.5 mg·d^-1.After 3 days,INR was 2.16 which reached the therapeutic target range of warfarin.On the same day,he was diagnosed as osteoporosis due to pain in the right hip and was treated with etoricoxib(60 mg,bid)and compound Sailong capsules(60 mg,bid).Three days later,he developed transient epistaxis.And lab test results showed that INR was 3.42 which was out of the therapeutic target range of warfarin.So the dose of warfarin was reduced to 3 mg·d^-1 and etoricoxib and compound Sailong capsules were stopped.But 2 days later,INR increased to 4.34 and warfarin was stopped at once.Subsequent monitoring results showed INR decreased to 2.21 on the 4th day after warfarin withdrawal.So he took warfarin(3 mg·d^-1,qd)again and discharged on that day.Follow-up results on two weeks after discharge showed that INR were 2.16,2.03,and 2.20 respectively and there were no epistaxis and other bleeding events.

关 键 词：华法林 出血 国际标准化比值 依托考昔 复方塞隆胶囊 相互作用 药品不良反应 

分 类 号：R969.3[医药卫生—药理学]