联合应用华法林与胺碘酮致国际标准化比值升高和血尿

1例42岁女性患者三尖瓣置换术后为预防血栓服用华法林（3．00mg／d）。用药第3天查凝血酶原时间（Pr）15．5S，国际标准化比值（INR）1．3，将华法林调整为3．75mg／d。第8天患者出现心房颤动，心率81次／min，遂加用胺碘酮0．2g，1次／d口服。第16天患者出现肉眼血尿。实验室检查：阿60．0S，INR5．1，尿红细胞计数300／m。停用华法林，胺碘酮维持原剂量，肌内注射维生素K110mg。4h后胛48．2S，INR4．1，再次肌内注射维生素K，10mg。4h后PT18．7S，INR1．6，尿液颜色逐渐恢复正常。第17天复查，PT16．6S，INR1．4，尿红细胞计数阴性，恢复华法林抗凝治疗（1．50mg／d）。

Elevated international normalized ratio and hematuresis following combined use of warfarin and amiodarone

A 42-year-old female received warfarin 3.00 mg/d to prevent thromboembolism after replacement of tricuspid valve. On day 3 of treatment, her prothrombin time （PT） was 15.5 s and the international normalized ratio （INR） was 1.3, warfarin was adjusted to 3.75 mg/d. On day 8, the patient presented atrial fibrillation, the heart rate was 81 beats/min, then amiodarone 0.2 g oral administration ouce daily was added. On day 16, the patient presented hematuria, laboratory tests showed the following values： PT 60. 0 s, INR 5. 1, urine red blood cell count 300/Ixl, warfarin was withdrawn immediately and amiodarone was maintained at the original dose. At the same time, the patient received an IM injection of vitamin K 10 mg. Four hours later, her PT and INR decreased to 48.2 s and 4.1, respectively. The patient was received an IM injection of vitamin K1 10 mg again. Four hours later, her PT and INR decreased to 18.7 s and 1.6, respectively. The urine color gradually returned to normal. On day 17, PT and INR were 18.7 s and 1.6, respectively, urine red blood cell count was zero. The anticoagulant therapy with warfarin 1.50 mg/d was resumed.