Riesselmann Benno, Hollmann Tanja, Tsokos Michael
State Institute of Legal and Social Medicine, Turmstrasse 21, Haus L, 10559 Berlin, Germany.
Leg Med (Tokyo). 2009 Apr;11 Suppl 1:S503-5. doi: 10.1016/j.legalmed.2009.03.011. Epub 2009 May 5.
Phenprocoumon is a derivative of coumarin, used as a preventative anticoagulant and in the treatment of thromboembolisms. On account of its pharmacodynamic and pharmacokinetic properties, strict surveillance of the patient is necessary. We report on two cases of undocumented administration of this active pharmaceutical ingredient. A 57-year-old woman was discovered by her husband in an inanimate state. The post-mortem examination revealed many extensive haematomas. On account of a suspicion of third-party negligence, an autopsy was performed the same day, during which was established that the cause of death was a clotting abnormality, the cause of which remained unclear. Toxicological analyses revealed a concentration of phenprocoumon of 7.8 mg/l. A 76-year-old man admitted himself to hospital immediately upon returning from a stay abroad. In hospital, extensive haematomas and a massive clotting abnormality (prothrombin ratio<10%) were discovered. A blood sample taken the following day yielded evidence of a phenprocoumon concentration of 3.1 mg/l. According to his general practitioner, no corresponding medications had been prescribed. Suspicion of foul play in the introduction of this active agent resulted in a police investigation. Both cases demonstrate the necessity of toxicological analyses in cases of clotting abnormalities.
苯丙香豆素是香豆素的衍生物，用作预防性抗凝剂和治疗血栓栓塞。鉴于其药效学和药代动力学特性，对患者进行严格监测是必要的。我们报告了两例该活性药物成分未记录用药情况的病例。一名57岁女性被丈夫发现处于无生命状态。尸检发现多处广泛血肿。由于怀疑第三方疏忽，当天进行了尸检，结果确定死因是凝血异常，但其原因尚不清楚。毒理学分析显示苯丙香豆素浓度为7.8毫克/升。一名76岁男性从国外旅行回来后立即入院。在医院里，发现了广泛的血肿和严重的凝血异常（凝血酶原比率<10%）。第二天采集的血样显示苯丙香豆素浓度为3.1毫克/升。据他的全科医生称，未开相应药物。怀疑引入这种活性剂存在不当行为，警方展开了调查。这两例病例均表明在凝血异常病例中进行毒理学分析的必要性。
