艾拉莫德与华法林联用致血浆凝血酶原时间延长

Prolonged prothrombin time caused by the combination of iguratimod and warfarin

1例59岁女性患者因风湿性心脏病、慢性心功能不全急性加重、类风湿关节炎、肺部感染等给予改善心功能、抗风湿(白芍总苷胶囊0.6 g口服、2次/d,艾拉莫德25 mg口服、2次/d)和抗感染等治疗。用药前凝血酶原时间(PT)15.5 s,国际标准化比值(INR)1.2。因考虑患者有心脏瓣膜病、左心房内附壁血栓等,次日加用华法林2.5 mg口服、1次/d。患者PT延长和INR升高,至应用华法林第10天,PT 45.0 s、INR 4.8。停用华法林,将艾拉莫德剂量降至25 mg口服、1次/d。停用华法林第2天,PT 53.2 s、INR 5.9;第3天,PT 80.8 s、INR 10.1,遂停用艾拉莫德,给予维生素K1治疗。3 d后,PT 22.4 s、INR 2.0。后因病情需要加用华法林2 mg口服、1次/d,患者PT为19.8~27.4 s、INR为2.1~2.9。考虑患者PT延长可能与艾拉莫德与华法林联用有关。

A 59‑year‑old female patient received treatments of improvement of heart function,anti‑rheumatism(oral total glucoside of white paeony capsules 0.6 g twice daily,oral iguratimod 25 mg twice daily),and anti‑infection,etc.due to rheumatic heart disease,acute exacerbation of chronic cardiac dysfunction,rheumatoid arthritis,and pulmonary infection.Before medication,the prothrombin time(PT)was 15.5 s,and the international normalized ratio(INR)was 1.2.Considering that the patient had valvular heart disease and mural thrombus in the left atrium,oral warfarin 2.5 mg once daily was added the next day.PT was prolonged and INR increased.On the 10th day of warfarin application,her PT was 45.0 s and INR was 4.8.Warfarin was discontinued and the dose of iguratimod was reduced to 25 mg orally once daily.On the 2nd day of warfarin discontinuation,PT was 53.2 s and INR was 5.9;on the 3rd day,PT was 80.8 s and INR was 10.1.Then iguratimod was stopped and vitamin K1 was given.After 3 days,the PT was 22.4 s and INR was 2.0.Later,oral warfarin 2 mg once daily was added due to the disease condition.The PT was 19.8 to 27.4 s and INR was 2.1 to 2.9.It was considered that the prolonged PT in the patients might be related to the combination of iguratimod and warfarin.