Chen Jiahao, Li Le, Wang Shiyu
Department of Pharmacy, The People's Hospital of Hezhou, Hezhou, China.
Medicine (Baltimore). 2024 Nov 22;103(47):e40658. doi: 10.1097/MD.0000000000040658.
Warfarin is the most commonly used drug in patients with mechanical valve replacement. Acute liver damage after warfarin is rare but potentially harmful. We present a case of warfarin-induced gastrointestinal bleeding with liver injury, pharmacy monitoring, and its therapy.
A 64-year-old woman with warfarin 4.5 mg medical history 10 years after mechanical mitral valve replacement. Who presented with gastrointestinal bleeding and extensive ecchymosis, due to rising international normalized ratio (INR), and then progressed to acute liver injury.
Warfarin poisoning.
Discontinuing warfarin, and artificial liver support system with anti-inflammatory liver therapy, which used reduced glutathione, polyene phosphatidylcholine, and ademetionine 1,4-butanedisulfonate for injection, ursodeoxycholic acid for orally.
The liver enzymes and hyperbilirubinemia were improved, she was placed on warfarin again, and the INR increased to 2.03. There was no significant increase in liver enzymes and hyperbilirubinemia, she was discharged on day 24.
Close monitoring and immediate dose adjustment of warfarin and to avoid drug-drug interaction. Timely stopped warfarin, adjusted INR and anti-inflammatory liver therapy may reduce the occurrence of warfarin-induced liver failure.
华法林是机械瓣膜置换患者最常用的药物。华法林导致的急性肝损伤虽罕见但可能有害。我们报告一例华法林引起的胃肠道出血伴肝损伤、药学监测及其治疗情况。
一名64岁女性，二尖瓣机械瓣置换术后10年，有服用4.5毫克华法林的病史。因国际标准化比值（INR）升高出现胃肠道出血和广泛瘀斑，随后进展为急性肝损伤。
华法林中毒。
停用华法林，采用人工肝支持系统并进行抗炎保肝治疗，使用还原型谷胱甘肽、多烯磷脂酰胆碱、注射用丁二磺酸腺苷蛋氨酸，口服熊去氧胆酸。
肝酶和高胆红素血症得到改善，再次服用华法林后，INR升至2.03。肝酶和高胆红素血症无显著升高，患者于第24天出院。
对华法林进行密切监测并及时调整剂量，避免药物相互作用。及时停用华法林、调整INR并进行抗炎保肝治疗可减少华法林所致肝衰竭的发生。
