Texas A&M Health Science Center College of Medicine, College Station, TX, USA.
Neurocrit Care. 2011 Jun;14(3):438-40. doi: 10.1007/s12028-011-9524-9.
The prevalent use of anticoagulation in a growing elderly population has led to an increasing incidence of intracerebral hemorrhage. Furthermore, the understanding of the interactions and adverse effects of oral anticoagulants when used with non-FDA approved drugs is limited. Diosmin is one such non-FDA approved drug which is a semisynthetic, phlebotropic supplement with multiple microcirculatory effects. We report a case of a patient on oral anticoagulation and diosmin, who presented with spontaneous intraventricular hemorrhage, and discuss the possible etiology behind this rare event.
A retrospective chart review and a comprehensive search of the literature using the PubMed database were performed.
A 77-year old female with a 6 week history of warfarin therapy and a several year history of diosmin use presented with severe bitemporal headache. Computed tomography scan revealed an acute hemorrhage within the right ventricle without associated intraparenchymal hemorrhage. International normalized ratio measured 1.8 and was corrected using fresh frozen plasma and vitamin K. She was discharged without neurological deficits.
Diosmin inhibits platelet aggregation and prolongs the effect of norepinephrine on venous tone, leading to increased venoconstriction. The combined effect of chronic microcirculatory hypertension and inhibition of platelet aggregation due to diosmin may have predisposed to spontaneous hemorrhage in this anticoagulated patient. Individual cases such as this serve as a reminder that over-the-counter dietary supplements may be associated with serious adverse events. The practicing clinician should be aware of this possible adverse event when evaluating patients on oral anticoagulation and chronic diosmin treatment.
在不断增长的老年人群中，抗凝剂的广泛使用导致了颅内出血的发生率不断增加。此外，对于口服抗凝剂与非 FDA 批准药物同时使用时的相互作用和不良反应的理解有限。地奥司明就是这样一种非 FDA 批准的药物，它是一种半合成的、具有多种微循环作用的静脉血管保护剂。我们报告了一例口服抗凝剂和地奥司明的患者出现自发性脑室内出血的病例，并讨论了这一罕见事件背后的可能病因。
我们进行了回顾性病历审查，并使用 PubMed 数据库进行了全面的文献搜索。
一名 77 岁女性，有 6 周华法林治疗史和数年地奥司明使用史，表现为严重的双侧颞部头痛。计算机断层扫描显示右侧心室急性出血，无伴发脑实质内出血。国际标准化比值为 1.8，通过新鲜冷冻血浆和维生素 K 纠正。她出院时没有神经功能缺损。
地奥司明抑制血小板聚集并延长去甲肾上腺素对静脉张力的作用，导致静脉收缩增加。慢性微循环高血压和地奥司明抑制血小板聚集的联合作用可能使该抗凝患者易发生自发性出血。此类个别病例提醒我们，非处方膳食补充剂可能与严重不良事件有关。当评估口服抗凝和慢性地奥司明治疗的患者时，临床医生应该意识到这种可能的不良反应。
