利伐沙班致肺栓塞患者异常子宫出血

Abnormal uterine bleeding induced by rivaroxaban in a patient with pulmonary embolism

1例49岁女性患者因肺栓塞服用利伐沙班(初始量:15 mg、2次/d,3周后维持量:20 mg、1次/d)抗凝治疗。从治疗当月开始患者月经量增多,经期由4~5 d延长至8~9 d。5个月后患者出现贫血,血红蛋白(Hb)53 g/L。考虑异常子宫出血与利伐沙班有关,停用利伐沙班,给予缩宫素及输血治疗,患者贫血好转。但2周后肺栓塞再发。给予低分子肝素和依诺肝素治疗,7 d后将依诺肝素逐渐过渡到华法林(4.5 mg/d)抗凝治疗,患者胸闷憋气症状好转,Hb 125 g/L。出院后继续服用华法林,门诊随访1个月,INR维持在2.00~3.33,月经恢复正常。

A 49-year-old female patient received anticoagulation therapy with rivaroxaban due to pulmonary embolism(initial dose:15 mg,twice daily;maintenance dose 3 weeks later:20 mg,once daily).From the month of treatment,the patient′s menstrual volume increased and menstrual period extended from 4-5 days to 8-9 days.Five months later,she developed anemia,with hemoglobin(Hb)53 g/L.Uterine bleeding was considered to be related to rivaroxaban.Rivaroxaban was stopped,oxytocin and blood transfusion were given,and her anemia was improved.But 2 weeks later,pulmonary embolism recurred in the patient.Low-molecular-weight heparin and enoxaparin were given and 7 days later,enoxaparin was gradually adjusted to warfarin therapy(4.5 mg/d).The symptoms of chest tightness and short of breath were improved and anemia was Hb 125 g/L.After discharge,warfarin was taken continuously.At 1 month of follow-up,her INR was maintained at 2.00-3.33 and menstruation returned to normal.