论文部分内容阅读
1例73岁男性患者在接受二尖瓣置换术后长期服用华法林,其国际标准化比值(INR)控制于2.0～3.0之间。患者因胃癌用卡培他滨化疗,在第二化疗周期内患者出现双足血疱、鼻衄、臀部瘀斑、黑便、肉眼血尿等症状及INR升高。立即停用华法林,给予新鲜冰冻血浆和维生素K1后,出血停止。华法林和卡培他滨减量后,INR控制于1.5～2.5,继续化疗时未再出血。华法林抗凝作用增强可能和卡培他滨抑制肝细胞色素P4502C9同工酶活性有关。复习文献发现,使用华法林患者加用卡培他滨后出血通常发生在联合治疗后2～6周,最常见的为胃肠道出血。为避免出血的发生,应密切监测凝血酶原时间(PT)和INR;华法林应个体化给药。
A 73-year-old man underwent long-term warfarin after a mitral valve replacement with an international normalized ratio (INR) between 2.0 and 3.0. Patients with capecitabine chemotherapy for gastric cancer, patients with second-trimester blood blisters, epistaxis, hip ecchymosis, melena, gross hematuria and other symptoms and INR increased in the second chemotherapy cycle. Warfarin is discontinued immediately and bleeding is stopped after fresh frozen plasma and vitamin K1 are given. Warfarin and capecitabine reduction, INR control in 1.5 to 2.5, no further bleeding when chemotherapy continued. Warfarin anticoagulation may be enhanced and capecitabine inhibit liver cytochrome P4502C9 isoenzyme activity. Review of the literature found that the use of warfarin patients with capecitabine bleeding usually occurs 2 to 6 weeks after the combination therapy, the most common gastrointestinal bleeding. To avoid the occurrence of bleeding, prothrombin time (PT) and INR should be closely monitored; warfarin should be administered individually.