华法林致皮下大面积出血及左心耳封堵预防心房颤动所致栓塞性疾病二例报告并文献复习

Large Area of Spontaneous Subcutaneous Hemorrhage Induced by Warfarin and Left Atrial Appendage Closure for Prevention of Thromboembolic Diseases in Atrial Fibrillation( A Report of Two cases and Its Relevant Literature Review)

目的探讨华法林致大面积皮下出血的诊治方法及左心耳封堵术在此类患者后续抗栓治疗中的应用价值。方法对我院收治的华法林致皮下大面积出血,并行经皮左心耳封堵术预防心房颤动所致栓塞性疾病2例的临床资料进行回顾性分析,并复习相关文献。结果本文2例均因心房颤动服用华法林致皮下大面积出血而就诊,经询问病史、仔细查体及凝血功能检查后确诊,停用华法林,给予维生素K肌内注射、输血等对症支持治疗后均病情好转,后皆成功施行经皮左心耳封堵术,1例随访至术后6个月,另1例随访至术后3个月,随访期间2例左心房均无血栓形成,无临床不良事件发生。结论华法林引起的皮下大面积出血必须引起临床医师重视。临床上具有高卒中、高出血风险,同时具有经皮左心耳封堵术适应证的心房颤动患者可积极建议行经皮左心耳封堵术。

Objective To discuss the diagnosis and treatment of the subcutaneous hemorrhage induced by Warfarin and the value of left atrial appendage closure applied to prevent patients with nonvalvular atrial fibrillation from having thrombosis. Methods We retrospectively analyzed two cases of large area of subcutaneous hemorrhage induced by Warfarin and left atrial appendage closure for prevention of thromboembolic diseases in atrial fibrillation after recovery. Some relevant literature was also attached to this article. Results Both the patients took Warfarin for atrial fibrillation and then they were admitted to our hospital for the subcutaneous hemorrhage induced by Warfarin. After a series of examinations,such as detailed enquiry of disease history,comprehensive physical examinations,coagulation test,their diagnosis was confirmed. They turned for the better after the discontinuation of Warfarin,intramuscular injection of Vitamin K,blood transfusion and symptomatic and supportive treatment. They underwent the percutaneous closure of the left atrial appendage successfully and no left atrial thrombosis and other clinical adverse cardiovascular events happened after a follow up for 3 and 6 months respectively. Conclusion Doctors must pay close attention to large area of subcutaneous hemorrhage after medication of Warfarin. Doctors should suggest that atrial fibrillation patients with high risks of bleeding and stroke and indications of percutaneous closure of the left atrial appendage undertake percutaneous closure of the left atrial appendage.