服用华法林期间饮用蒲公英水致消化道出血  

Gastrointestinal bleeding caused by drinking water soaked with dandelion during warfarin administration

作　　者：王丽岩[1] 陈艳伟[1] 栗云明[1] WangLiyan;Chen Yanwei;Li Yunming(Department of Pharmacy,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院药学部,大连116011

出　　处：《药物不良反应杂志》2020年第11期650-651,共2页Adverse Drug Reactions Journal

摘　　要：1例55岁男性二尖瓣重度关闭不全患者行二尖瓣机械瓣置换术后长期服用华法林抗凝治疗,国际标准化比值(INR)维持在2.00~3.00。因口腔溃疡,患者用自购的蒲公英晒干后泡服代茶饮。15 d后,患者轻微活动即出现胸闷、气短、心悸、乏力,继而出现恶心、呕吐,双下肢轻度水肿,夜间端坐呼吸,右下肢瘀斑,大便呈黑色;实验室检查示血红蛋白52 g/L,红细胞计数2.05×1012/L。考虑为消化道出血,可能与服用华法林期间饮用蒲公英水有关。停用华法林,停饮蒲公英水。给予滤白悬浮红细胞2 U静脉滴注、1次/d,共2次,埃索美拉唑80 mg静脉滴注、2次/d,维生素K1 10 mg肌内注射和20 mg口服各1次等对症治疗。2 d后患者INR 1.58,血红蛋白84 g/L,红细胞计数2.33×1012/L;5 d后INR为1.63,血红蛋白104 g/L,红细胞计数3.92×1012/L。A 55-year-old male patient with severe mitral valve insufficiency received long-time warfarin anticoagulation therapy after mechanical mitral valve replacement and the international standard ratio(INR)was 2.00-3.00.Because of oral ulcers,he took the water soaked with dandelion(Taraxacum mongolicum Hand-Mass),which was self-purchased and sun-dried,for daily drinking.Fifteen days later,the patient developed chest tightness,shortness of breath,palpitation,and fatigue,followed by nausea,vomiting,mild edema of the lower limbs,orthopnea at night,ecchymosis on the right lower limb,and black stool successively.Laboratory tests showed hemoglobin 52 g/L,red blood cell count 2.05×1012/L.Gastrointestinal bleeding was considered,which might be related to the water soaked with dandelion drunk during warfarin therapy.Warfarin and water soaked with dandelion were stopped.The patient received symptomatic treatments including IV infusions of leukocyte-depleted red blood cell suspension 2 units(2 times in total)and esomeprazole 80 mg(twice daily),an intramuscular injection of vitamin K1 10 mg,and oral vitamin K1 20 mg.Two days later,the patientzs INR was 1.58,hemoglobin was 84 g/L,and red blood cell count was 2.33xlOl2/L.Five days later,his INR was 1.63,hemoglobin was 104g/L,and red blood cell count was 3.92× 1012/L.

关 键 词：华法林 蒲公英属 中草药 草药-药物相互作用 

分 类 号：R969.3[医药卫生—药理学]