心血管内科患者华法林与其他药物联用相关的血发生情况分析

目的了解联用华法林与其他药物的心血管内科患者因药物相互作用相关的出血发生情况并探讨控制措施。方法收集北京大学第一医院心血管内科2012年1月至2013年6月住院期间应用华法林患者的病历资料进行回顾性分析，记录患者合并用药情况及可能由于药物相互作用而导致的出血发生情况，筛选与华法林存在相互作用的心血管内科常用药物。结果纳入分析的患者141例，男性90例，年龄21～83岁，平均（63±13）岁；女性51例，年龄43～85岁，平均（65±11）岁；原发病以心房颤动居多，为112例，占79．4％。141例患者中，可能由于华法林与合并用药相互作用而发生轻微出血者14例，占9．9％。其中，大便潜血5例，皮肤瘀斑3例，手术切口渗血、口腔黏膜及痰中带血、阴道出血、鼻出血、血尿和牙龈出血各1例。14例患者出血发生共涉及9种药物，包括低分子肝素（相关9例）、阿托伐他汀（相关6例）、胺碘酮（相关4例）、阿卡波糖（相关3例）、阿司匹林（相关4例）、普罗帕酮（相关3例）、奥美拉唑（相关2例）、氯吡格雷（相关2例）和莫西沙星（相关1例）；其中，以低分子肝素最多，约占64．2％。这9种药物在141例患者中与华法林的联用率以低分子肝素最高，为73．1％（103／141）；联用相关出血发生率以莫西沙星最高，为1／5。结论华法林与部分临床常用心血管药物联用可因药物相互作用而导致患者发生出血。积极开展华法林临床药学监护对预防出血发生具有重要意义。

Analysis of occurrence of bleeding related to combination therapy with warfarin and other drugs in patients in Department of Cardiovascular Medicine

Objective To understand occurrence of bleeding related to drug interactions in patients who received combined treatment with warfarin and other drugs in Department of Cardiovascular Medicine and investigate control measures. Methods The data of inpatients using warfarin in the Department of Cardiovascular Medicine, Peking University First Hospital from January 2012 to June 2013 were collected and analyzed retrospectively. The conditions of concomitant drugs and occurrence of bleeding possibly caused by drug interactions were recorded and the drugs which were commonly used in the Department were screened. Results A total of 141 patients were enrolled including 90 men aged from 21 to 83 years with an average age of （63 ± 13 ） years and 51 women aged from 43 to 85 years with an average age of （65 ± 11 ） years. Most protopathy was atrial fibrillation which accounted for 79.4% （112 cases）. Of the 141 patients, there were 14 cases （9.9%） of slight bleeding possibly because of drug interactions including 5 cases of stool occult blood, 3 cases of dermal ecchymosis and 1 case had each of the following： operative wound bleeding, oral mucosal bleeding and blood in phlegm, colporrhagia, epistaxis, hematuresis, and gum bleeding. The occurrence of bleeding in the 14 patients involved totally 9 kinds of drugs containing low molecular weight heparin （ related to 9 cases）, atorvastatin （ related to 6 cases）, amiodarone （ related to 4 cases） , acarbose （related to 3 cases ） , aspirin （related to 4 cases ） , propafenone （related to 3 cases ） , omeprazole （related to 2 cases） , clopidogrel （related to 2 cases） , and moxifloxacin （related to 1 case ） and, of them, the highest occurrence was due to low molecular weight heparin, which accounted for 64.2%. In the 9 kinds of drugs in the 141 patients, low molecular weight heparin had the highest concomitant frecluencv combined with warfarin accounted for 73.1% （103/141） and moxifloxacin had the highestbleeding incidence accounted of 1/5. Conclusions Bleeding may be caused by drug reactions due to combination therapy with warfarin and parts of clinical common cardiovascular drugs. Positive clinical pharmaceutical care of warfarin will be of great importance in prevention of bleeding.