Petersen D, Barthels M
Institut für Klinische Chemie, Medizinischen Hochschule Hannover.
Med Klin (Munich). 1995 May 15;90(5):277-83.
It is frequently difficult to disclose covert ingestion of cumarins being the underlying cause of a bleeding disorder.
We report on 16 cases (15 patients) of phenprocoumon (Marcumar) abuse. All patients (9 females, 6 males) were admitted to the hospital because of bleeding and/or prolonged thromboplastin times. Analysis of phenprocoumon in the blood was performed by HPLC.
The clinical presentation of the bleeding was highly variable. Thromboplastin times ranged from < 5 to 58%. With the exception of two patients with hepatic dysfunctions factor V activity was normal. All but one patient denied the ingestion of Marcumar. One patient died from hemorrhage. Two types of patients emerge from our series: Type I is the young nurse (8 cases), type II the usually male patient formerly treated with phenprocoumon (5 cases). Type I patients had long medical histories and showed autoaggressive behavior including the artificial manipulation of disorders other than hemorrhage. Thromboplastin times however were within or close to the therapeutic range (10 to 25%). Type II patients did not simulate other diseases in addition to hemorrhage. Thromboplastin times were longer than in type I patients. In all instances discrimination between non suicidal and suicidal behaviour was difficult. Psychiatric consultance is indicated.
隐匿摄入香豆素作为出血性疾病的潜在病因往往难以发现。
我们报告了16例（15名患者）苯丙香豆素（Marcumar）滥用病例。所有患者（9名女性，6名男性）因出血和/或凝血酶原时间延长入院。采用高效液相色谱法对血液中的苯丙香豆素进行分析。
出血的临床表现差异很大。凝血酶原时间范围从<5到58%。除两名肝功能不全患者外，因子V活性正常。除一名患者外，所有患者均否认摄入Marcumar。一名患者死于出血。我们的系列研究中出现了两种类型的患者：I型是年轻护士（8例），II型通常是曾接受过苯丙香豆素治疗的男性患者（5例）。I型患者有较长的病史，表现出自我攻击行为，包括人为操纵出血以外的疾病。然而，凝血酶原时间在治疗范围内或接近治疗范围（10%至25%）。II型患者除出血外不模拟其他疾病。凝血酶原时间比I型患者长。在所有情况下，区分非自杀行为和自杀行为都很困难。建议进行精神科会诊。
