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目的各种糖尿病药物层出不穷,与华法林联用发生药物相互作用是临床药师需关注的,艾塞那肽作为新型降糖药,与华法林联用的报道少,本研究拟探讨二者之间相互作用及可能机制,指导患者合理和个体化用药。方法通过对一例糖尿病合并房颤患者联用华法林与艾塞那肽进行病例分析,介绍艾塞那肽作为新型2型糖尿病药物的特点,并分析艾塞那肽与华法林的相互作用。结果患者使用艾塞那肽后INR值从2.13降至1.57,艾塞那肽加量后INR值降至1.43,停药后INR值呈上升趋势,出院时INR值1.78。出院后随访INR值已经恢复至2~3。结论房颤时血液易在心房内淤积而形成血栓,糖尿病患者高凝状态发生血栓的危险性增加,临床上糖尿病合并房颤患者比例大。华法林是目前应用最广泛的口服抗凝药之一,影响因素较多,使用时需要监测凝血酶原时间国际标准化比值(INR)。艾塞那肽因减缓胃排空从而影响华法林的吸收导致INR值降低,两药联用时应密切监测INR值,及时调整华法林剂量。
Purpose A variety of diabetes drugs emerge in an endless stream, and the drug interaction with warfarin is a clinical pharmacist should pay attention, exenatide as a new hypoglycemic agents, combined with the report less warfarin, the study to explore both The interaction between and possible mechanisms to guide patients rational and individualized medication. Methods A case of diabetic patients with atrial fibrillation combined with warfarin and exenatide case analysis of exenatide as a novel type 2 diabetes drug characteristics and analysis of exenatide and warfarin interaction . Results After treatment with exenatide, the INR value decreased from 2.13 to 1.57. After the amount of exenatide was added, the INR value dropped to 1.43. The INR value showed an upward trend after discharge, with an INR value of 1.78 at discharge. Follow-up after discharge INR value has been restored to 2 ~ 3. Conclusion Atrial fibrillation is easy to form blood clots in the atrium, and the risk of thrombosis in patients with hypercoagulable state of diabetes is increased. Clinically, the proportion of patients with diabetes complicated with atrial fibrillation is large. Warfarin is currently one of the most widely used oral anticoagulants, affecting many factors, the need to monitor the use of prothrombin time international standardization ratio (INR). Exenatide due to gastric emptying and thus affect the absorption of warfarin lead to lower INR value, the two drugs should be closely monitored when the INR value, timely adjustment of warfarin dose.