华法林片致儿童非创伤性自发性肌肉出血1例分析  

Spontaneous muscular hemorrhage induced by warfarin tablets in a child

作　　者：郭军[1] 任丹[1] 叶龙 赵荣香[1] 王宇[3] 余静[1] GUO Jun;REN Dan;YE Long;ZHAO Rongxiang;WANG Yu;YU Jing(Department of Pediatrics,Mianyang Central Hospital,Mianyang Sichuan 621000,China;Department of Radiology,Mianyang Central Hospital,Mianyang Sichuan 621000,China;Department of Pharmacy,Mianyang Central Hospital,Mianyang Sichuan 621000,China)

机构地区：[1]绵阳市中心医院儿科,四川绵阳621000 [2]绵阳市中心医院放射科,四川绵阳621000 [3]绵阳市中心医院药剂科,四川绵阳621000

出　　处：《中国药物警戒》2022年第3期339-341,344,共4页Chinese Journal of Pharmacovigilance

摘　　要：目的探讨特殊时期慢性病患儿使用华法林的凝血功能监测方法。方法报道1例因新型冠状病毒肺炎疫情影响,导致川崎病巨大冠状动脉瘤患儿服用华法林联合阿司匹林抗凝期间未正规随访而出现非创伤性自发性下肢肌肉出血的病例,探索疫情期间慢性病患儿使用华法林的应对措施。结果患儿因受疫情影响未能正规随访导致凝血功能障碍,并出现严重的非创伤性自发性肌肉出血,经输血、改善凝血功能等对症治疗,患儿出血停止,活动恢复。结论华法林是目前川崎病合并冠状动脉瘤治疗的常用抗凝药物,若临床抗凝过度与不足都能引起严重的并发症。医务人员要重视疫情等特殊时期抗凝剂的用药监护,同时还需重视非常见部位出血的早期发现与及时救治。Objective To explore ways to monitor coagulation functions of warfarin in children with chronic diseases amid COVID-19.Methods One case of Kawasaki disease with a giant coronary aneurysm was reported,who had developed non-traumatic spontaneous lower extremity muscle hemorrhage during anticoagulation with warfarin and aspirin but without regular follow-up amid COVID-19.Response measures against the use of warfarin in children with chronic diseases during the pandemic were explored.Results Because of the COVID-19 pandemic,the child failed to be followed up regularly,resulting in coagulation dysfunction and serious non-invasive spontaneous muscle hemorrhage.After blood transfusion and improvement of coagulation function,the bleeding was stopped and the lower limb activity restored.Conclusion Warfarin is a commonly-used anticoagulant against Kawasaki disease combined with a coronary artery aneurysm,but excessive or insufficient anticoagulation can cause serious complications.Therefore,the INR of patients needs to be monitored.Clinicians should use anticoagulants with caution during the epidemic and remain alert to bleeding in unusual locations.

关 键 词：华法林 新型冠状病毒肺炎 川崎病 自发性肌肉出血 

分 类 号：R994.11[医药卫生—毒理学]