In-Chul Park, Yang-Hyun Baek, Sang-Young Han, Sung-Wook Lee, Won-Tae Chung, Sung-Won Lee, Sang-Hyeon Kang, Duk-Song Cho, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Dong-A University, Busan 602-715, South Korea.
World J Gastroenterol. 2013 Oct 14;19(38):6494-9. doi: 10.3748/wjg.v19.i38.6494.
Warfarin is a widely used anticoagulant. Interindividual differences in drug response, a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically. An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she developed right flank pain. We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy. After stopping oral anticoagulation, a follow-up computed tomography showed improvement in the hemorrhage. After restarting warfarin because of a recurrent thrombosis, the intrahepatic hemorrhage recurred. We decided to start clopidogrel and hydroxychloroquine instead of warfarin. The patient has not developed further recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.
华法林是一种广泛应用的抗凝剂。药物反应的个体差异、治疗窗狭窄以及出血风险使得华法林在临床应用中颇具难度。一名 18 岁的抗磷脂综合征女性患者因复发性深静脉血栓而接受长期华法林治疗。6 年后，她出现右侧腰痛。我们诊断为抗凝治疗引起的肝内和帽状腱膜下出血。停用口服抗凝药物后，随访 CT 显示出血改善。由于复发性血栓再次开始华法林治疗后，肝内出血再次发生。我们决定开始使用氯吡格雷和羟氯喹代替华法林。此后患者未再发生血栓形成或出血事件。肝内出血是华法林非常罕见的并发症，尽管我们的患者没有出血或国际标准化比值控制不稳定的风险因素，但仍发生了肝内和帽状腱膜下出血。
