华法林与胺碘酮联用致抗凝过度引起华法林相关肾病  

Warfarin-related nephropathy due to excessive anticoagulation induced by combination of warfarin and amiodarone

作　　者：范彩霞 郭德群 李峥嵘[1] 孙桂玲[2] Fan Caixia;Guo Dequn;Li Zhengrong;Sun Guiling(Department of Pharmacy,Linyi City People′s Hospital,Shangdong Province,Linyi 276000,China;Department of Cardiovascular Medicine,Linyi People′s Hospital,Shangdong Province,Linyi 276000,China)

机构地区：[1]临沂市人民医院药学部,临沂276000 [2]临沂市人民医院心血管内科,临沂276000

出　　处：《药物不良反应杂志》2024年第5期318-320,共3页Adverse Drug Reactions Journal

基　　金：山东省医药卫生科技发展计划项目(202203011106);山东省医学会临床科研专项资金-临床药学应用研究项目(YXH2019ZX015);临沂市科技发展计划项目(202120078)。

摘　　要：1例49岁男性患者接受主动脉机械瓣置换术后长期口服华法林(5-mg、1次/d),国际标准化比值(INR)维持在1.80~2.50。因房性心动过速联用胺碘酮治疗,1周后出现鼻腔出血,实验室检查示凝血酶原时间(PT)79.7-s,INR 10.17,血清肌酐(Scr)1-032-μmol/L,血尿素氮(BUN)29.4-mmol/L;尿常规检查显示尿潜血(+),尿蛋白(±)。考虑为联用胺碘酮增强华法林抗凝作用导致华法林抗凝过度,进而引起华法林相关肾病。停用华法林,给予局部止血和维生素K1、氨甲环酸、百令胶囊、碳酸镧咀嚼片及连续血液透析等治疗。5 d后恢复使用华法林,2周后实验室检查示PT 21.0-s,INR 1.82,Scr 179-μmol/L,BUN 19.0-mmol/L;2个月和6个月后复查肾功能指标均在参考值范围。A 49-year-old male patient received long-term use of warfarin 5-mg once daily orally after the operation of aortic mechanical valve replacement, and the international normalized ratio (INR) was maintained at 1.80~2.50. The patient was treated with amiodarone due to atrial tachycardia, and developed nasal bleeding 1 week later. Laboratory tests showed prothrombin time (PT) 79.7-s, INR 10.17, serum creatinine (Scr) 1-032-μmol/L, and blood urea nitrogen (BUN) 29.4-mmol/L;urine routine examination showed urinary occult blood (+) and urinary protein (±). Considering that it was warfarin-related nephropathy caused by the combination of amiodarone, which can enhance the anticoagulant effect of warfarin, leading to excessive anticoagulation. Warfarin was discontinued and the treatments such as local hemostasis, vitamin K1, tranexamic acid, Bailing capsules (百令胶囊), lanthanum carbonate chewable tablets, and continuous hemodialysis were given. Five days of drug withdrawal, warfarin was restored. Two weeks later, laboratory tests showed PT 21.0-s, INR 1.82, Scr 179-μmol/L, and BUN 19.0-mmol/L. Renal function indicators were within the reference range at 2 and 6 months of follow-up.

关 键 词：抗凝药 华法林 急性肾损伤 华法林相关肾病 胺碘酮 药物相互作用 

分 类 号：R969[医药卫生—药理学]