Cebicci Huseyin, Gurbuz Sukru, Gunay Nurullah, Vural Abdussamed
Department of Emergency Medicine, Kayseri Education and Research Hospital, Kayseri, Turkey.
BMJ Case Rep. 2013 Nov 18;2013:bcr2013201042. doi: 10.1136/bcr-2013-201042.
Warfarin is widely used. Spontaneous bleeding is one of the complications of warfarin treatment. A 70-year-old man was admitted to the emergency room with right back pain. There was no history of trauma. He was using warfarin following a bypass graft. The patient's vital signs were stable. On physical examination, swelling at the level of the right scapula was detected. Laboratory findings showed that the international normalised ratio (INR) was ↑↑ (a very high reading) (1.47 1 month previously). There was no melena on rectal examination. A chest CT was performed to differentiate the swelling of the right scapula. Warfarin was stopped and vitamin K was administered. Fresh frozen plasma was initiated and the patient was hospitalised to the cardiovascular surgical service. The fact that use of warfarin in the elderly may increase the risk of spontaneous bleeding should be especially kept in mind.
华法林被广泛使用。自发性出血是华法林治疗的并发症之一。一名70岁男性因右背部疼痛被送入急诊室。无外伤史。他在接受搭桥移植术后一直在使用华法林。患者生命体征稳定。体格检查发现右肩胛水平处有肿胀。实验室检查结果显示国际标准化比值（INR）↑↑（读数非常高）（1个月前为1.47）。直肠检查未发现黑便。进行胸部CT以鉴别右肩胛肿胀的原因。停用华法林并给予维生素K。开始输注新鲜冰冻血浆，并将患者收住心血管外科。应特别牢记老年人使用华法林可能会增加自发性出血的风险这一事实。
