Hulse M L
Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, PA 19104, USA.
Pharmacotherapy. 1996 Nov-Dec;16(6):1009-17.
Warfarin resistance is a rare phenomenon, and most of the related literature obtained in a MEDLINE search from 1964-1995 consists of case reports. Warfarin resistance may develop as a result of noncompliance, exogenous consumption of vitamin K, and concurrent ingestion of other agents known to decrease warfarin's effects. There are three documented cases of hereditary resistance and one case of loose documentation of hereditary resistance with confirmation of similar resistant patterns in family members. Data on two of the three cases may support the postulation that hereditary resistance may be caused by the presence of an abnormal receptor or enzyme that has an increased affinity for vitamin K. To date, this receptor or enzyme has not been identified. To assess a subtherapeutic dose response to oral anticoagulation, the clinician must consider many possible causes of resistance, such as noncompliance, drug interactions, laboratory error, or pharmacokinetic changes. Once these have been ruled out, it is possible to consider that a tissue resistance to warfarin may be responsible.
华法林抵抗是一种罕见现象，1964年至1995年在医学文献数据库检索中获得的大部分相关文献均为病例报告。华法林抵抗可能因不依从、外源性维生素K摄入以及同时服用其他已知会降低华法林效果的药物而产生。有3例遗传性抵抗的记录病例以及1例遗传性抵抗记录不完整但家庭成员中证实有类似抵抗模式的病例。3例病例中的2例数据可能支持这样一种假设，即遗传性抵抗可能是由对维生素K具有更高亲和力的异常受体或酶的存在所致。迄今为止，尚未鉴定出这种受体或酶。为评估口服抗凝治疗的亚治疗剂量反应，临床医生必须考虑许多可能的抵抗原因，如不依从、药物相互作用、实验室误差或药代动力学变化。一旦排除这些因素，就有可能认为组织对华法林的抵抗可能是原因所在。
