长期口服华法林后肌内注射安乃近致臀部血肿

Buttock hematoma caused by intramuscular injection of dipyrone after long-term use of oral warfarin

1例心脏瓣膜置换术后一直口服华法林(2.5 mg,1次/d,已5年)的51岁男性患者因感冒肌内注射安乃近(剂量不详),第3天出现左臀部肿痛、皮下瘀斑。超声检查示左臀部皮下低回声区。实验室检查:国际标准化比值(INR)6.2。停用华法林,静脉滴注维生素K_1 40 mg,1次/d。3 d后,INR降至1.0,行左臀切开引流术。术后第2天INR 1.2,恢复原剂量华法林口服。2周后,瘀斑面积减小,INR 2.0。术后6周瘀斑完全消退,INR 2.1。

A 51-year-old male patient, who was treated with warfarin 2.5 mg once daily for 5 years after cardiac valve replacement, received IM dipyrone for his cold （dose not stated）. He developed pain, swelling and ecchymosis of left buttock after 3 days. Ultrasonic examination showed low echo area on the left buttock. Laboratory tests showed an international normalized ratio （INR） 6.2. Warfarin was stopped and an IV infusion of vitamin Kl 40 mg once daily was given. Three days later, the INR value decreased to 1.0. Incision and drainage on the left buttock was performed. On the second day after operation, the INR was 1.2 and warfarin was received again according to original dosage. Two weeks later, the area of ecchymosis was reduced, and INR level was 2.0. After one month of follow-up, the eechymosis subsided completely, the INR level was 2.1.