Aldridge M A, Ito M K
University of Pacific, Stockton, California, and Veterans Administration San Diego Healthcare System, USA.
Pharmacotherapy. 2001 Jul;21(7):886-9. doi: 10.1592/phco.21.9.886.34556.
A 79-year-old man with atrial fibrillation and coronary heart disease who was taking warfarin (Coumadin) was converted to fenofibrate from gemfibrozil therapy for persistently elevated triglyceride levels. The patient took fenofibrate for 1 month and subsequently experienced rectal bleeding that required a visit to the emergency room. Before starting fenofibrate therapy, his coagulation values were within therapeutic range, but when measured in the emergency room the international normalized ratio (INR) was grossly elevated. The patient denied any changes in diet, alcohol ingestion, compliance with therapy, or use of other new drugs except for fenofibrate. His drug therapy profile consisted of digoxin, fosinopril, and furosemide for chronic heart failure, allopurinol for gout, and potassium supplementation. To minimize the risk of supratherapeutic INR values and/or hemorrhagic events, clinicians should perform serial monitoring of INR when initiating fenofibrate therapy in a patient previously stabilized on a coumarin anticoagulant.
一名79岁患有心房颤动和冠心病且正在服用华法林（香豆素）的男性患者，因甘油三酯水平持续升高，从吉非贝齐治疗转换为非诺贝特治疗。该患者服用非诺贝特1个月后，随后出现直肠出血，需要前往急诊室就诊。在开始非诺贝特治疗前，其凝血值在治疗范围内，但在急诊室测量时，国际标准化比值（INR）大幅升高。患者否认饮食、酒精摄入、治疗依从性有任何变化，除了非诺贝特外也未使用其他新药。他的药物治疗方案包括用于慢性心力衰竭的地高辛、福辛普利和呋塞米，用于痛风的别嘌醇以及补钾。为了将INR值超治疗范围和/或出血事件的风险降至最低，临床医生在先前使用香豆素类抗凝剂已稳定的患者中开始非诺贝特治疗时，应进行INR的连续监测。
