心脏瓣膜置换术后服用华法林引起皮肤坏死一例

Warfarin-induced skin necrosis after heart valve replacement:a case report

1例70岁男性患者行主动脉根部替换术(生物瓣)联合升主动脉置换术后第2天启用华法林抗凝治疗,服药10 d后出现双下肢黑斑、继发溃烂,采取停用华法林、予以依诺肝素钠注射液替代抗凝治疗等措施后,症状逐渐缓解。10 d后重启华法林治疗,3 d后再次出现下肢黑斑、继发溃烂,当日检测INR值为1.0,遂再次停用华法林,改用达肝素钠注射液抗凝治疗后,下肢黑斑逐渐好转。抗凝门诊药师与医师经过共同探讨,确定该不良反应为华法林引起的皮肤坏死。3个月后随访患者,无皮肤损伤、出血和血栓栓塞等不良反应。

A 70-year-old male patient who underwent aortic root replacement(biological valve)combined with ascen⁃ding aorta replacement,and was given warfarin anticoagulation treatment on the second day.After 10 days of drug administra⁃tion,black spots and secondary ulceration appeared on both lower limbs.Warfarin was stopped and enoxaparin sodium injec⁃tion was given instead of anticoagulation treatment,and the symptoms were gradually relieved.Warfarin treatment was restarted after 10 days,and black spots and secondary ulceration appeared again after 3 days,while INR value was 1.0 on the same day.Therefore,warfarin was stopped again,and anticoagulation treatment was switched to heparin sodium injection,and the black spots of lower limbs gradually improved.After discussion,pharmacists and doctors in anticoagulation clinic determined that the adverse event was warfarin-induced skin necrosis.There were no adverse reactions such as skin injury,bleeding and thromboembolism at 3 months follow-up.