摘要
1例50岁女性患者,因诊断肺栓塞及结肠癌肝转移,15 d前开始口服华法林钠片3 mg,qd,并于8 d前口服卡培他滨片1 g,bid。此次为接受进一步治疗入我院。入院时检测患者国际标准化比值(INR)3.41,临床药师建议将华法林钠片剂量减至2.25 mg,qd,并密切监测INR值。入院第5天复查INR 4.56,夜间出现消化道出血。经停用华法林,给予维生素K1,输注红细胞、血浆等对症治疗后,患者出血停止。后调整抗凝方案为达肝素钠5000 iu,皮下注射,bid,患者未再发生出血症状。
A 50-year-old female patient took warfarin(3 mg,qd)15 days ago for pulmonary embolism and capecitabine(1 g,bid)8 days ago for recurrent colorectal liver metastases.The patient was admitted to the hospital for further treatment.After admission,the lab results showed that the international normalized ratio(INR)value was 3.41,and pharmacists suggested reducing the dose of warfarin to 2.25 mg once daily and continuing monitoring INR closely.The INR increased to 4.56 on the 5 th day after admission and the patient developed serious gastrointestinal bleeding at that night.Warfarin was withdrawn immediately.Bleeding stopped gradually after administration of fresh plasma,red blood cell and vitamin K1.And then warfarin was replaced with dalteparin sodium injection(5000 iu,sc,bid)and there was no bleeding event again.
作者
袁晓刚
高攀
杨彦伟
YUAN Xiao-gang;GAO Pan;YANG Yan-wei(The First Affiliated Hospital of Henan University,Kaifeng 475001,China)
出处
《中国药物应用与监测》
CAS
2019年第6期351-353,共3页
Chinese Journal of Drug Application and Monitoring
基金
开封市科技发展计划项目(1703014)
