University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Infect Dis. 2012 Oct 26;12:272. doi: 10.1186/1471-2334-12-272.
Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. This is the first case report in published literature describing this therapeutic dilemma.
A fifty one year old Sri Lankan woman was diagnosed with dengue haemorrhagic fever with bleeding manifestations. During the critical phase of her illness, the platelet count dropped to 5,000/ɥl. She was also on warfarin 7 mg daily following a prosthetic mitral valve insertion. In managing the patient, the risk of bleeding had to be balanced against the risk of valve thrombosis without anticoagulation. Warfarin was withheld when the platelet count dropped to 100,000/ɥl and restarted when it recovered above 50,000/ɥl. The patient was off anticoagulation for 10 days.
We managed this patient with close observation and continuous risk benefit assessments of management decisions. However, experience with one patient cannot be generalized to others. Therefore, it is essential that clinicians share their experiences in managing such difficult patients.
严重登革热感染的管理是一项挑战，特别是当并发其他合并症时。我们报告了一例患有登革出血热和自发性出血的患者，需要对人工二尖瓣置换进行强制性抗凝治疗。这是首例在已发表的文献中描述这种治疗困境的病例报告。
一名 51 岁的斯里兰卡妇女被诊断为登革出血热伴出血表现。在她疾病的危急阶段，血小板计数降至 5000/μl。她在人工二尖瓣插入后每天还服用华法林 7 毫克。在治疗患者时，必须权衡出血风险与无抗凝治疗时瓣膜血栓形成的风险。当血小板计数降至 100,000/μl 时，停止使用华法林，当血小板计数恢复到 50,000/μl 以上时重新开始使用。患者停止抗凝治疗 10 天。
我们通过密切观察和对管理决策的持续风险效益评估来管理这名患者。然而，一个患者的经验不能推广到其他人。因此，临床医生分享管理此类困难患者的经验至关重要。
