论文部分内容阅读
目的探讨非诺贝特对华法林抗凝作用的影响、作用机制和处理方法。方法 1位78岁老年男性患者长期稳定服用华法林抗凝治疗,在服用非诺贝特2周后出现咳血、血尿和左下肢疼痛,急诊查INR值为5.9,予停用华法林、肌注维生素K1 10 mg处理后出院,随后根据INR值调整华法林周剂量下降40%后INR值达到稳定,半个月后患者因肌痛停用非诺贝特,INR值连续2周持续下降,调整华法林剂量至接近服用非诺贝特前。结果患者在稳定的华法林治疗剂量基础上加用非诺贝特后,增加了华法林的抗凝效果。非诺贝特蛋白结合率高,可能把与白蛋白结合的华法林置换下来,导致抗凝效果增强;非诺贝特也是轻到中度的CYP2C9抑制剂,CYP2C9为S型华法林的代谢酶。这2种作用合起来可增强华法林的药效。结论在长期华法林稳定抗凝治疗的情况下加用非诺贝特后,建议连续监测INR值并考虑经验性降低华法林剂量20%,之后根据INR值继续调整剂量至稳定。
Objective To investigate the effect, mechanism and treatment of fenofibrate on warfarin anticoagulation. Methods A 78-year-old man with a long history of stable anticoagulation with warfarin and cough, hematuria and left lower extremity after 2 weeks of fenofibrate treatment received an emergency INR of 5.9 and warfarin, After treatment with 10 mg of vitamin K1, the INR was adjusted and the INR value stabilized after a 40% decrease in warfarin weekly dose. After two weeks, the patient was stopped using fenofibrate for myalgiasia. The INR value continued to decline for two weeks , Adjust the warfarin dose to near before taking fenofibrate. Results The addition of fenofibrate to the stable warfarin dose increased the anticoagulation effect of warfarin. Fenofibrate has a high binding rate and may displace albumin-bound warfarin, leading to increased anticoagulation; fenofibrate is also a mild to moderate CYP2C9 inhibitor and CYP2C9 is S-type warfarin Metabolic enzymes. Together, these two effects enhance the efficacy of warfarin. Conclusions After long-term warfarin stabilization with anticoagulant therapy plus fenofibrate, it is advisable to continuously monitor INR and to consider empirically reducing the warfarin dose by 20% and then continue to adjust the dose to stabilization based on the INR value.