Brophy D F, Ford S L, Crouch M A
Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond 23298-0533, USA.
Pharmacotherapy. 1998 May-Jun;18(3):646-9.
Drug therapy in short bowel syndrome can be complicated by inadequate or incomplete absorption of drugs in the small intestine. Many case reports claim that warfarin absorption is not affected by the syndrome. We treated a patient with oral warfarin for recurring deep vein thrombosis; up to 20 mg/day was administered with no increase in the international normalized ratio. Drug-drug interactions that may prevent absorption, increase metabolism, or antagonize the effects of warfarin were ruled out. Intravenous lipid administration, which is anecdotally reported to precipitate warfarin resistance, may have contributed to the condition, but dosing was less frequent than in published reports. The most probable explanation of warfarin resistance is the reduced surface area for drug absorption secondary to surgical removal of the patient's duodenum and gastrojejunostomy.
短肠综合征的药物治疗可能因小肠对药物的吸收不足或不完全而变得复杂。许多病例报告称华法林的吸收不受该综合征影响。我们治疗了一名患有复发性深静脉血栓形成的患者，口服华法林，每日剂量高达20毫克，但国际标准化比值并未升高。排除了可能阻止华法林吸收、增加其代谢或拮抗其作用的药物相互作用。静脉输注脂质据传闻会导致华法林抵抗，这可能是导致该情况的原因之一，但给药频率低于已发表报告中的频率。华法林抵抗最可能的解释是患者十二指肠手术切除和胃空肠吻合术后药物吸收表面积减少。
