华法林致机体出血30例临床特点分析

Clinical characteristics of 30 patients with hemorrhage induced by application of Warfarin

目的探讨口服华法林药物所致机体出血患者临床特点,并评估重新应用华法林后再出血的危险。方法记录30例服用华法林患者出血时INR范围、出血部位,逆转华法林作用的方式及治疗强度,服华法林后再次出血及死亡的原因。结果 2例因脑疝死亡,28例治愈,其中1例发生右侧腘动脉血栓伴侧枝循环形成,1例2年内反复出现3次上消化出血并1次失血性休克。结论华法林致机体出血好发于服药开始3个月及1年以上者,多因患者未定时监测INR,提示调整治疗强度的INR对减少出血发生率的必要性,强调抗凝宣教及加强随访的重要性。此外,停用华法林血栓栓塞的危险度低,但恢复华法令治疗少数可有复发出血。

Objective To investigate the clinical characteristics of patients with hemorrhage induced by application of warfarin,and to assess the risk of re-bleeding after reapplication of Warfarin.Methods INR value,bleeding site,the way and treatment intensity of the reversal of Warfarin were recorded in 30 cases with hemorrhage patients resulting from Warfarin,and the cause of bleeding again and death in the patients with oral reapplication of Warfarin were analyzed.Results Two cases died from cerebral hernia,while the other 28 cases were cured,but one of which showed right popliteal artery thrombosis accompanied by formation of collateral circulation,another case presented three times of upper gastrointestinal hemorrhage,and combined with one hemorrhagic shock within two year.Conclusions As for the patients with hemorrhage induced by Warfarin which first occurred after three months of drug intake and over year,the main reason is irregular monitoring of INR.Our data indicates that it is necessary to promptly adjust the dose of Warfarin according to the INR ratio,which can reduce the bleeding risk of overdosed Warfarin.Moreover,it is important to emphasize the education of anticoagulation and follow-up of patients.In addition,the risk of thromboembolism in the patients of stopping taking in Warfarin is low,and the restoration of Warfarin therapy may be accompanied by recurrent hemorrhage in a few patients.