达托霉素致PT/INR异常升高的病例分析及文献复习

Case Analysis and Literature Review of Daptomycin Induced Abnormal Prolongation of PT/INR

目的提高对达托霉素(daptomycin,DAP)致凝血酶原时间/国际标准化比值(prothrombin time/internationalnormalized ratio,PT/INR)假性升高的临床认识。方法对1 例使用DAP 致PT/INR 异常升高患者的临床资料进行回顾性分析,并复习相关文献。结果本例患者PT/INR 异常升高考虑为DAP 与测定PT 所用试剂间的相互作用而引起的假性升高,未予维生素K 拮抗治疗,并及时加用华法林抗凝治疗,降低了患者发生血栓的风险。结论随着耐药菌的出现,DAP 在临床上的应用逐渐增多,应重视使用DAP 时PT/INR 异常升高的现象,特别是在接受华法林抗凝治疗的患者中应采用多种检测方法复测患者的凝血功能水平,减少因检测方法的缺陷导致临床治疗的失误。

OBJECTIVE To improve the clinical recognition of daptomycin induced artificial prolongation of prothrombin time/international normalized ratios(PT/INR).METHODS Clinical data of a case of daptomycin induced abnormal prolongation of PT/INR were retrospectively analyzed,and reviewed the literature.RESULTS Abnormal prolongation of PT/INR in this patient was considered to cause by daptomycin interacting with some test reagents of PT.Therefore,the patient didn't receive vitamin K therapy,and warfarin was added in time to reduce the risk of thromboembolic events.CONCLUSION With the emergence of drug-resistant bacteria,the clinical application of daptomycin is gradually increasing,abnormal prolongation of PT/INR in patients who treated with daptomycin should be paid more attention,especially for the warfarin users, coagulation function should be tested by other methods to decrease mistakes in clinical treatment due to defects in test methods.