Kostka R, Havlůj L, Jirava D, Novák L, Vach B, Weiss J
Chirurgická klinika 3. LF UK a FNKV Praha.
Rozhl Chir. 2010 Feb;89(2):124-9.
Introduction of warfarin use in prevention and treatment of thromboembolic diseases resulted in lower rates of thromboembolic complications, however, on the other hand, it has been associated with increased incidence of hemorrhagic complications,which often require surgical management. AIM, MATERIAL, METHODS: The aim of the study was a retrospective analysis of hemorrhagic complications in 184 patients, hospitalized in the FNKV (Královské Vinohrady Faculty Hospital) Surgical Clinic during 2000-2008, following warfarin overdose. The following diagnostic or treatment methods were used: endoscopy of the upper or lower GIT in GIT hemorrhages and spiral CT when peritoneal bleeding was suspected.
GIT bleeding, such as hematemesis, melena, enterorrhagy, was the commonest complication observed in 147 patients, ie. 79.9%. Upper GIT was identified as the source of bleeding in 76 subjects, i.e. 51.7%, lower GIT was the identified source in 26 subjects, ie. 17.7%, and the source remained unidentified in 45 patients, ie. in 30.6%. 10 patients suffered from soft tissue bleeding, m. rectus abdominis hematoma was detected in 7 subjects, hemoperitoneum and/or retrohemoperitoneum was identified in 8 subjects. Intestinal wall or its intestinal peritoneum was affected in 3 subjects and 3 patients suffered from liver or splenic intraparenchymal hematoma. Out of the total of 184 patients, 165 subjects were treated conservatively (89.7%), 19 subjects underwent surgery (10.3%), including 14 laparotomies for acute abdomen symptoms and 5 incisions with removal of hematomas. Overall lethality rate was 7/184, ie. 3.8%, 5 subjects undergoing conservative treatment and 2 subjects undergoing surgery exited.
Uncontrolled warfarin administration may cause serious, even life- threatening complications. Therefore, patients undergoing warfarin therapy should be adequately informed about potential complications and regular INR monitoring is required.
华法林用于预防和治疗血栓栓塞性疾病可降低血栓栓塞并发症的发生率，然而，另一方面，它与出血并发症发生率的增加有关，而出血并发症往往需要手术处理。目的、材料、方法：本研究的目的是对2000年至2008年期间在FNKV（克拉洛维·维诺赫拉迪大学医院）外科诊所住院的184例华法林过量患者的出血并发症进行回顾性分析。采用了以下诊断或治疗方法：上消化道或下消化道出血时进行上消化道或下消化道内镜检查，怀疑有腹腔内出血时进行螺旋CT检查。
147例患者出现了最常见的并发症，即胃肠道出血，如呕血、黑便、肠出血，占79.9%。76例患者上消化道被确定为出血源，占51.7%；26例患者下消化道被确定为出血源，占17.7%；45例患者出血源未明确，占30.6%。10例患者出现软组织出血，7例患者检测到腹直肌血肿，8例患者发现腹腔积血和/或腹膜后积血。3例患者的肠壁或其肠腹膜受到影响，3例患者出现肝实质内或脾实质内血肿。在184例患者中，165例接受了保守治疗（89.7%），19例接受了手术（10.3%），包括14例因急腹症症状进行的剖腹手术和5例清除血肿的切口手术。总死亡率为7/184，即3.8%，5例接受保守治疗的患者和2例接受手术的患者死亡。
华法林使用不当可能导致严重甚至危及生命的并发症。因此，接受华法林治疗的患者应充分了解潜在并发症，并需要定期监测国际标准化比值（INR）。
