口服华法令抗凝致出血的原因分析

Study on the Causes of Hemorrhage due to Oral Warfarin Therapy

目的：探讨口服华法令抗凝治疗期间患者出血的相关原因。方法：收集60例因口服华法令抗凝治疗期间合并出血的急诊患者的临床资料，分析在不同凝血酶原时间（PT-INR）值范围内导致出血的相关病因。结果：60例服用华法令合并出血的病例中，24例（40．0％）所测PT-INR在2．0～3.0的目标值内，并且9例患者INR〈2．0；进一步检查发现这33例患者基本都合并有不同的易促使出血的疾病。结论：服用华法令抗凝治疗期间发生出血与否并不完全取决于PT-INR值，还决定于自身潜在的疾病等相关原因；临床应用华法令时应因人而异地调整剂量并决定其抗凝强度。

Objective. To analyse the causes of warfarin-associated hemorrhage among adult patients with oral warfarin therapy. Methods： 60 bleeding patients during oral warfarin therapy were recruited into the study. To analyse the correlative causes of hemorrhage in different range of INR. Result： Of the 60 patients, 24 patients＇（40. 0 %） international normalized ratio（INR） were between 2.0 and 3. 0; 9 patients＇ were 〈2. 0. During the follow-up,all of 33 patients were found to have different coexisted clinical diseases causing hemorrhage. Conclusion： The observations suggest that, when warfarin is being initiated, not only commonly employed INR should be measured for the prevention of bleeding, but also latent clinical diseases causing hemorrhage should be considered. The dosage of oral warfarin therapy should be individualized.