Konishi Yasunobu, Terada Takafumi, Araki Yoshimori, Kawaguchi Osamu
Department of Cardiac Surgery, Toyota Kosei Hospital, Japan.
Intern Med. 2019 Nov 15;58(22):3251-3253. doi: 10.2169/internalmedicine.2973-19. Epub 2019 Jul 10.
Flutamide, a chemotherapeutic agent for prostate cancer, is known to enhance warfarin anticoagulation. However, not much is known about its pharmaceutical interaction. We herein report the case of a patient with an implanted pacemaker for atrial fibrillation with bradycardia who was on warfarin. This patient presented with deterioration of hematuria, gingival, ear, and subcutaneous bleeding. The prothrombin time-international normalized ratio was extremely elevated after starting flutamide to treat progression of prostate cancer. Fatal bleeding complications were able to be prevented by the immediate administration of prothrombin complex concentrate, but the effect of flutamide on warfarin was prolonged for about two more weeks after the withdrawal of flutamide.
氟他胺是一种用于治疗前列腺癌的化疗药物，已知它会增强华法林的抗凝作用。然而，关于其药物相互作用的了解并不多。我们在此报告一例患有植入式起搏器的心房颤动伴心动过缓患者，该患者正在服用华法林。该患者出现血尿、牙龈、耳部和皮下出血加重。在开始使用氟他胺治疗前列腺癌进展后，凝血酶原时间-国际标准化比值极度升高。通过立即给予凝血酶原复合物浓缩剂，成功预防了致命的出血并发症，但在停用氟他胺后，氟他胺对华法林的影响仍持续了约两周。
