Rosa Chamith Thushanga, Navinan Mitrakrishnan Rayno, Samarawickrama Sincy, Hamza Himam, Gunarathne Maheshika, Arulanantham Arulprashanth, Subba Neeha, Samarasiri Udari, Mathias Thushara, Kulatunga Aruna
Internal Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Res Notes. 2017 Jan 7;10(1):26. doi: 10.1186/s13104-016-2330-x.
The management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. The use and continuation of warfarin in dengue virus infection is one such example.
We report a 65 year old South Asian female who presented with dengue fever. She had a history bronchial asthma, a prior abdominal surgery, and was on warfarin and maintained a therapeutically appropriate internationalized normalized ratio for a mechanical aortic valve replacement. Though preemptive decision to stop warfarin was taken with decreasing platelet counts, her clinical course was complicated with the development of bilateral rectus sheath haematoma's requiring resuscitation with blood transfusions.
Though management of dengue viral fever has seen drastic evolution with recent updated guidance, clinical scenarios seen in the course of the illness still pose challenges to the managing physician. The need to continue obligatory anticoagulation which may seem counterintuitive during a complex disease such as dengue virus infection must be considered after understanding the potential risks versus that of its benefits. Though case by case decisions maybe warranted, a clear protocol would be very helpful in making clinical decisions, as the correct preemptive decision may potentially avert catastrophic and unpredictable bleeding events.
登革病毒感染的管理可能具有挑战性。登革热本身多样的临床表现和众多并发症增加了治疗的复杂性和潜在死亡率。当面临额外的合并症以及需要继续服用强制性药物时，缺乏明确的逐步确定性指导，患者往往会出现更复杂的并发症和结果，这使得人们对可能做出的临床决策产生质疑。在登革病毒感染中使用和继续使用华法林就是这样一个例子。
我们报告一名65岁的南亚女性，她出现了登革热症状。她有支气管哮喘病史，曾接受过腹部手术，正在服用华法林，并且对于机械主动脉瓣置换术维持着治疗上合适的国际标准化比值。尽管随着血小板计数下降已做出停用华法林的预先决定，但她的临床病程仍很复杂，出现了双侧腹直肌鞘血肿，需要输血复苏。
尽管随着最近更新的指导，登革热病毒热的管理有了巨大进展，但疾病过程中出现的临床情况仍然给主治医生带来挑战。在登革病毒感染等复杂疾病期间，继续进行强制性抗凝治疗的必要性看似违反直觉，但在了解其潜在风险与益处后必须予以考虑。尽管可能需要逐案做出决定，但明确的方案对于做出临床决策非常有帮助，因为正确的预先决定可能会避免灾难性和不可预测的出血事件。
