摘要
1例73岁男性患者在接受二尖瓣置换术后长期服用华法林,其国际标准化比值(INR)控制于2.0～3.0之间。患者因胃癌用卡培他滨化疗,在第二化疗周期内患者出现双足血疱、鼻衄、臀部瘀斑、黑便、肉眼血尿等症状及INR升高。立即停用华法林,给予新鲜冰冻血浆和维生素K1后,出血停止。华法林和卡培他滨减量后,INR控制于1.5～2.5,继续化疗时未再出血。华法林抗凝作用增强可能和卡培他滨抑制肝细胞色素P4502C9同工酶活性有关。复习文献发现,使用华法林患者加用卡培他滨后出血通常发生在联合治疗后2～6周,最常见的为胃肠道出血。为避免出血的发生,应密切监测凝血酶原时间(PT)和INR;华法林应个体化给药。
A 73-year-old man received a prolonged treatment with warfarin after undergoing mitral valve replacement, and his international normalized ratio （ INR ） was maintained between 2.0 - 3.0. The patient received capecitabine chemotherapy due to stomach cancer. During the second cycle of the chemotherapy, he developed hemorrhagic blisters on his feet, nose bleeding, ecchymoses on his buttock, melena, and gross hematuria, and his INR increased. Warfarin was withdrawn immediately. Bleeding stopped after administration of fresh frozen plasma replacement and vitamin K1. The INR was maintained between 1.5 - 2.5 after the dosages of warfarin and capecitabine were decreased, and the chemotherapy continued and no further bleeding occurred. The increased anticoagulant effect of warfarin may be associated with the capecitabine-induced suppression of cytochrome P450 2C9 isoenzyme. A review of the literature indicates bleeding occurring in patient receiving warfarin plus capecitabine usually is within 2 - 6 weeks after initiation of the combined chemotherapy. The most common hemorrhage is gastrointestinal bleeding. In order to avoid bleeding occurring, prothrombin time （PT） and INR should be closely monitored, and the dosage of warfarin should be individualized.
出处
《药物不良反应杂志》
2009年第1期47-49,共3页
Adverse Drug Reactions Journal
关键词
卡培他滨
华法林
药物相互作用
国际标准化比值
出血
capecitabine
warfarin
drug interaction
international normalized ratio
hemorrhage
