1例华法林诱导的严重自身免疫性肝炎的药学监护

Pharmaceutical care for a patient with warfarin-induced autoimmune hepatitis

华法林作为临床常用的抗凝剂,广泛应用于人工瓣膜、心房颤动以及各种血栓栓塞性疾病的预防和治疗。目前对于华法林使用的药学监护点主要集中于其疗效、安全性监测、个体化治疗和相互作用,不良反应方面则集中关注在出血症状的识别和防范以及国际标准化比值（international normalized ratio,INR）升高的对症处理等,而对于华法林可能诱导自身免疫性肝炎尚无防范和鉴别意识。

Here we reported a patient with warfarin-induced autoimmune hepatitis （AIH）, and ex- plored new concerns for the pharmaceutical care of warfarin. A 57-year-old woman was admitted to hospi- tal for repeated anorexia, abdominal pain and abnormal liver function. She received prosthetic heart valve replacement because of rheumatic heart disease, and had started warfarin medication since 2 years before. Her liver function was elevated with highest alanine aminotransferase 861 U/L, aspertate aminotransferase 604 U/L, and total bilirubin 106.7 μmol/L. Her anticoagulant therapy was switched to low molecular weight heparin and the liver function returned to normal. The liver function was elevated when she started to take warfarin again. The patient was then on liver protection therapy, and warfarin was stopped again for the liver biopsy for diagnosis reason. Through medication consultation and evalua- tion, pharmacists were invited to work together with the physicians and helped to differentiate the reason for abnormal liver function, and provided therapeutic suggestions. Also the pharmacists gained experiences in the treatment of AIH, and discovered a new and severe adverse drug reaction for warfarin. In treating this case, the pharmacists＇ active involvement into the treatment and evaluation of the effect on the patient reflected the advantage and importance of the multidisciplinary cooperation for pharmacists and physicians when complex diseases are faced.