华法林与曲马多相互作用致严重出血的药学监护1例报道

Pharmaceutical care of serious bleeding induced by tramadol-warfarin interaction: a case report

华法林是一种香豆素衍生物,通过抑制维生素K依赖的凝血因子而发挥抗凝作用,是心房颤动患者最常用的抗凝药。华法林的主要不良反应是出血,每年出血事件的发生率为7%~8%,是急诊中引起药物不良事件的常见原因[1-2]。同时,很多药物可以与华法林产生药物相互作用,影响华法林的抗凝疗效,增加出血或栓塞的风险。

Warfarin is a high-alert medication,which may result in bleeding if used improperly. In our case,one elderly female with atrial fibrillation had taken warfarin for more than half a year,and her international normalized ratio（INR） was maintained within the therapeutic range. The patient began to take tramadol to alleviate her shoulder pain. Three days later she presented hematuresis and had ecchymosis in her right upper arm,and in the meantime her INR rose to 10. 04. Clinical pharmacists analyzed the cause for bleeding by searching relevant literature,and finally discovered the interaction between warfarin and tramadol. On the basis of that,the clinical pharmacists provided pharmaceutical care,offered specific medication education,as well as assisted the physicians to establish the medication plan for warfarin reuse. Eventually,her INR declined to reference ranges,and her hematuresis and ecchymosis were alleviated significantly. This successful case reveals that clinical pharmacy services contribute to better treatment outcomes. Clinical pharmacists can play an active role in anticoagulation management in healthcare team.