反复发作的抗凝血类灭鼠药致获得性凝血功能障碍三例

Paroxysmal Acquired Coagulopathy Caused by Anticoagulant Rodenticides:A Report of ree Cases and the Literature Review

目的分析反复发作的抗凝血类灭鼠药所致获得性凝血功能障碍的临床特点,探讨其诊治方案。方法对2009年3月-2010年12月收治的3例抗凝血类灭鼠药所致获得性凝血功能障碍患者的临床表现、实验室检查和治疗转归进行分析,并复习相关文献。结果 3例患者均以同时出现多部位出血为首发表现,经应用维生素K1、凝血酶原复合物、新鲜冰冻血浆、冷沉淀等治疗,患者病情好转,实验室指标恢复正常。停药(2、5周,3个月)后再次出现多部位出血,再给予维生素K1等治疗,病情可缓解。结论维生素K1可作为首选的治疗药物,且对反复发作的患者同样有效。为避免再发性出血,应维持治疗至少3个月。

Objective To analyze the clinical features of paroxysmal acquired coagulopathy caused by anticoagulant rodenticides and to investigate its diagnosis and treatment.Methods We analyzed the clinical manifestations,laboratory examinations and outcomes of 3 cases of acquired coagulopathy caused by anticoagulant rodenticides diagnosed between March 2009 and December 2010 and reviewed related literatures.Results The initial symptom of all the 3 patients was simultaneous multi-site hemorrhage.After accepting the therapy of Vitamin K1,thrombin,fresh frozen plasma and cryoprecipitate,all the 3 patients acquired clinical remission and normal laboratory parameters.After withdrawal of the medicine（2 weeks,5 weeks and 3 months respectively）,all 3 patients had multi-site hemorrhage again,and remission was achieved after the administration of Vitamin K1.Conclusions Vitamin K1 can be used as the primary therapy for paroxysmal acquired coagulopathy caused by anticoagulant rodenticides and is effective for recurrent patients.To prevent recurrent bleeding,the treatment should be maintained for at least 3 months.