Keréveur A, Trossaert M, Horellou M H, Conard J, Dupeyron J P, Samama M
Service d'hématologie biologique, hôpital de l'Hôtel-Dieu, Paris.
Arch Mal Coeur Vaiss. 1995 Apr;88(4):487-95.
During the initial phase or during treatment with oral anticoagulants, hypersensitivity or resistance may be observed, requiring significant changes in prescribed dosage. A thorough knowledge of the mode of action of vitamin K and its antagonists is useful to improve understanding of unexpected response to oral anticoagulant therapy. These abnormal responses may be due to poor compliance to treatment by the patient, insufficient or excessive vitamin K intake, interference with other drugs or abnormalities of the hepatic enzymes which are the target of oral anticoagulant drugs. The search for a cause is justified by the risks associated with these abnormal responses. It must be rigorously undertaken with an accurate interrogation, use of an anticoagulation monitoring leaflet and, if necessary, measurement of plasma concentrations and pharmacokinetics of the anticoagulant drug.
在初始阶段或口服抗凝剂治疗期间，可能会观察到超敏反应或耐药性，这需要大幅调整规定剂量。深入了解维生素K及其拮抗剂的作用方式，有助于更好地理解口服抗凝剂治疗中的意外反应。这些异常反应可能是由于患者治疗依从性差、维生素K摄入不足或过量、与其他药物的相互作用，或口服抗凝剂药物作用靶点的肝酶异常。鉴于这些异常反应带来的风险，寻找原因是合理的。必须通过准确询问、使用抗凝监测手册，并在必要时测量抗凝药物的血浆浓度和药代动力学，来严格进行排查。
