华法林在川崎病合并冠状动脉瘤中的治疗进展

川崎病是儿童急性多系统血管炎性疾病,已成为儿童后天获得性心脏病常见原因之一,其冠状动脉病变是多见并发症.临床上川崎病冠状动脉病变严重程度分5级,其中Ⅳ级(巨大冠状动脉瘤;或1支冠状动脉内多个动脉瘤,但无狭窄者)和Ⅴ级(冠状动脉造影显示有狭窄或闭塞,伴或不伴心肌缺血)患儿推荐长期口服小剂量阿司匹林联合华法林或注射低分子肝素.该文旨在结合国内外研究,从华法林适应证、初始剂量、国际标准化比值、维持剂量范围、华法林在川崎病治疗中的影响因素(年龄、性别、身高、体重、目标INR)、药物与食物相互作用、不良反应以及近年来因华法林在不同个体用药差异性较大而被学者逐渐重视起来的基因研究(如VKORC1、CYP2C9)等来阐述华法林在川崎病合并冠状动脉瘤中的治疗进展.未来需更多高质量大样本多中心随机研究进一步明确影响因素,为其合理有效而安全的应用提供建议,实现精准医疗.

Warfarin therapy in Kawasaki disease with coronary aneurysms

Kawasaki disease (KD),an acute systemic vasculitis disease,has become one of the most common causes of acquired heart diseases in children.Coronary artery lesion(CAL) is the most important complication of KD.Clinically,the lesion degree can be classified into Ⅰ ～ Ⅴ.For pediatric patients with CAL at Ⅳ degree(giant aneurysms or multiple aneurysms in one coronary artery without stenosis)or Ⅴ degree(stenosis or obstruction shown in coronary angiography,with or without myocardial ischemia),a long-term medication therapy of a low dosage aspirin combined with warfarin or low-molecular-weight heparin is recommended.This review summarizes,the indications,the starting dose,international normalized ratio(INR),and maintenance dose.The related factors,including clinical features (like age,gender,height,weight,target INR),drug interaction,food interaction,adverse reactions and genotypes(VKORC1,CYP2C9)are also considered in warfarin treatment of KD with coronary aneurysms.Multicenter RCTs with high quality and large sample size are required in order to provide advice for reasonable,effective,and safe application as well as to achieve precision medicine.