1例深静脉血栓老年患者抗凝治疗致腹膜后出血的病例分析

Analysis of One Case of Senior Patient with Deep Vein Thrombosis Occurred Retroperitoneal Bleeding during Anticoagulant Therapy

目的:通过对1例深静脉血栓老年患者抗凝治疗过程中发生严重出血的病例进行分析,提高对抗凝过程中出血风险的认识。方法:结合患者病史、实验室相关检查、治疗经过,对出血可能原因进行分析。结果:该患者出血可能原因为:(1)华法林与达肝素联合使用出现药物不良反应;(2)治疗过程中出现白蛋白降低,可能致华法林抗凝作用增强;(3)该患者为老年人,治疗过程中出现肌酐清除率的减低,可能对华法林的清除减少。结论:临床中对于老年患者的抗凝治疗更需谨慎,增加相关实验室检查的频率,可及时发现潜在的风险。

Objective ： To improve the recognition of bleeding risk in the anticoagulant process by analyzing one case of senior patient with deep vein thrombosis occurred severe bleeding during the anticoagulant therapy. Methods： The possible causes of hemorrhage were analyzed after the brief introduction of medical history, lab test report and treatment process of the patient. Results： The reasons of hemorrhage might be as follows ： （1） the combination of warfarin and dalteparin induced the adverse drug reaction ; （2） albumin decreased during the treatment process resulting in the effect enhancement of warfarin; （3） the clearance of warfarin decreased resulting from the low creatinine clearance of the elderly patient. Conclusion ： Clinical anticoagulant practice should be more careful in senior patients. The frequency of related laboratory tests should be increased in order to find potential risks timely.