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Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1637-1641页

作者： Vitale, N De Feo, M De Santo, LS Pollice, A Tedesco, N Cotrufo, M Second Univ Naples Monaldi Hosp Sch Med Dept Cardiac Surg Naples Italy Univ Bari Dept Stat Sci Bari Italy

OBJECTIVES The purpose of this study was to assess the incidence of warfarin fetal complications and whether they are dose-dependent. BACKGROUND Gravid patients with mechanical heart valves require long-term anticoagulant therapy. Controversy exists concerning the appropriate treatment of these patients. METHODS Forty-three women on warfarin carrying out 58 pregnancies were studied. For each patient with full-term pregnancy a caesarian section was scheduled for the 38th week during brief warfarin discontinuation. Maternal and fetal complications were evaluated. Fetal complications were divided according to the warfarin dosage less than or equal to 5 mg and >5 mg necessary to keep an international normalized ratio (INR) of 2.5 to 3.5, and analyzed subsequently. RESULTS A total of 58 pregnancies were observed: 31 healthy babies (30 full term, 1 premature) and 27 fetal complications (22 spontaneous abortions, 2 warfarin embryopathies, 1 stillbirth, 1 ventricular septal defect, 1 growth retardation) were recorded. Two maternal valve thromboses occurred. No fetal or maternal bleeding was observed during caesarian sections or premature vaginal delivery. Patients whose warfarin doses during pregnancy were >5 mg had 22 fetal complications, whereas those taking a dose less than or equal to 5 mg had only five fetal complications (p = 0.0001). For an increase of the warfarin dose there was a substantially increased probability of fetal complications (p < 0.0001;rho < 0.7316). CONCLUSIONS There is a dose dependency between warfarin dosage and fetal complications. Patients on warfarin anticoagulation may be delivered by planned caesarian section at the 38th week while briefly interrupting anticoagulation. (C) 1999 by the American College of Cardiology.

关键词：畸形药物性/病因学抗凝药/投药和剂量抗凝药/副作用剖宫产术剂量效应关系药物死胎/病因学心脏瓣膜假体植入国际标准化比妊娠并发症心血管/药物疗法假体失效血栓形成/药物疗法华法林/投药和剂量华法林/副作用女(雌)性人类婴儿新生男(雄)性妊娠

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Seven cases of interaction between warfarin and cyclooxygenase-2 inhibitors

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第21期58卷 2076-2080页

作者： Stading, JA Skrabal, MZ Faulkner, MA Creighton Univ Sch Pharm & Allied Hlth Profess Dept Pharm Practice Omaha NE 68178 USA

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Warfarin use and fracture risk

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NUTRITION REVIEWS 2000年第1期58卷 20-22页

作者： Booth, SL Tufts Univ Vitamin K Program Jean Mayer Human Nutr Res Ctr Aging USDA Boston MA 02111 USA

Two recent studies examined the association between chronic use of warfarin, a vitamin K antagonist, and fracture rate among older women. Whereas one study reported no association, the other reported a significantly higher risk for vertebral and rib fractures among warfarin users compared with nonusers. The effect of vitamin K antagonists on age-related bone loss continues to be controversial.

关键词：抗凝药/副作用骨折/病因学骨质疏松绝经后/病因学维生素K/拮抗剂和抑制剂华法林/副作用妇女卫生动物女(雌)性人类

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INTRAMURAL INTESTINAL HEMORRHAGE - COMPLICATION OF ANTICOAGULANT THERAPY

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POSTGRADUATE MEDICAL JOURNAL 1975年第592期51卷 107-110页

作者： HALE, JE WESTMINSTER HOSP LONDON SW1ENGLAND

The history is presented of a patient on long term anticoagulant therapy who developed signs of intestinal obstruction due to haematoma in the small bowel. The difficulties of diagnosis and management are considered, ... 详细信息

关键词：胃肠出血/化学诱导胃肠出血/并发症胃肠出血/诊断人工心脏瓣膜血肿/化学诱导血肿/并发症血肿/诊断肠梗阻/诊断肠梗阻/病因学手术后并发症/预防和控制血栓形成/预防和控制华法林/副作用华法林/治疗应用老年人女(雌)性人类

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Prospective evaluation of a modified Fennerty regimen for anticoagulating elderly people

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AGE AND AGEING 1998年第5期27卷 655-656页

作者： Cooper, MW Hendra, TJ Royal Hallamshire Hosp Dept Geriatr Med Sheffield S10 2JF S Yorkshire England

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OVARIAN HEMORRHAGE COMPLICATING WARFARIN SODIUM ANTICOAGULANT THERAPY

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1976年第7期124卷 766-767页

作者： MATSEOANE, S BATTS, JA MANDEVILLE, EO COLUMBIA UNIV HARLEM HOSP CTR DEPT OBSTET & GYNECOL NEW YORK NY 10037 USA

Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparotomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.

关键词：卵巢囊肿/化学诱导卵巢疾病/化学诱导肺栓塞/药物疗法破裂自发性华法林/副作用华法林/治疗应用成年人女(雌)性人类

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Characteristics of patients with antiphospholipid syndrome with major bleeding after oral anticoagulant treatment

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ANNALS OF THE RHEUMATIC DISEASES 2001年第5期60卷 527-530页

作者： Castellino, G Cuadrado, MJ Godfrey, T Khamashta, MA Hughes, GRV St Thomass Hosp Rayne Inst Lupus Res Unit London SE1 7EH England

Objective-To study the demographic and clinical characteristics of patients with antiphospholipid syndrome (APS) with serious haemorrhagic complications of anticoagulant treatment in an attempt to establish risk factors for bleeding. Methods-Patients with APS who were attending our lupus unit and who presented with severe bleeding while receiving oral anticoagulation were studied retrospectively. Severe bleeding was defined by the need for admission to hospital. Demographic data, clinical features, concomitant diseases and drugs, warfarin doses, duration of anticoagulation, and International Normalised Ratios (INR) at the time of bleeding were collected. Results-Fifteen patients were included in the study (12 with systemic lupus erythematosus (SLE) plus APS and 3 with primary APS). The median age was 41.7 (range 27-66) and the median duration of the disease was 12.9 years (range 3-22). Duration of anticoagulation was between 10 days and 17 years. The INR at the time of bleeding was under 3 in 4 patients, between 3 and 4 in 5 patients and above 4 in 6 patients. There were 1 episodes of subdural haematoma, 4 episodes of renal haematoma (two after renal biopsy), 2 episodes of ovarian haemorrhage, 2 episodes of rectal haemorrhage, 1 episode of menorrhagia, 1 episode of haemarthrosis, and 1 episode of spinal haematoma. Concomitant drugs were aspirin in 9 patients, antibiotics in 2 patients, and azathioprine in 3 patients. In 6 patients hypertension was present as a concomitant disease. There were no deaths due to bleeding. Anticoagulant treatment was restarted in all patients and 3 of them had a new episode of bleeding. Conclusion-No relation was established between age, duration of oral anticoagulant treatment, and bleeding. Concomitant drugs, mainly aspirin, and high blood pressure were present at the time of bleeding in a large number of patients.

关键词：消炎药非甾类/治疗应用抗凝药/副作用抗磷脂综合征/并发症抗磷脂综合征/药物疗法阿司匹林/治疗应用关节积血/化学诱导血肿/化学诱导血肿硬膜下/化学诱导出血/化学诱导高血压/并发症肾疾病/化学诱导月经过多/化学诱导卵巢疾病/化学诱导复发危险因素血栓形成/并发症血栓形成/预防和控制华法林/副作用成年人老年人女(雌)性人类男(雄)性中年人

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华法林致肺、消化道出血1例

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安徽医药 2020年第9期24卷 1900-1904页

作者：殷悦轩刘子琦韩艳丽郭煜山东中医药大学第二临床医学院山东济南250014 山东中医药大学第二附属医院心血管内科山东济南250001

目的总结1例左心室附壁血栓病人因服用华法林不当导致肺、消化道出血的诊疗过程,探讨华法林钠片抗凝治疗过程的个体化剂量、不良反应及依从性等问题。方法回顾性分析2019年6月山东中医药大学第二附属医院心内科收治的1例因左心室附壁血... 详细信息

目的总结1例左心室附壁血栓病人因服用华法林不当导致肺、消化道出血的诊疗过程,探讨华法林钠片抗凝治疗过程的个体化剂量、不良反应及依从性等问题。方法回顾性分析2019年6月山东中医药大学第二附属医院心内科收治的1例因左心室附壁血栓过量服用华法林导致肺、消化道出血的病人临床资料,探讨其安全性。结果给予该病人强心利尿、纠正贫血、抗感染等对症治疗,应用维生素K1注射液(VitK1)治疗3 d后,国际标准化比值由19.07降至1.04,病人凝血功能恢复正常,出院后随访3月余,病人未再出现相关并发症。结论华法林钠片的临床应用存在较大的个体差异,容易受到诸多因素的影响,医务工作者应密切监测病人国际标准化比值,及时调整华法林的剂量,保证抗凝治疗的效用与安全。

关键词：华法林/副作用维生素K1 出血左心室附壁血栓国际标准化比值

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Possible interaction between gatifloxacin and warfarin

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2002年第12期59卷 1205-1206页

作者： Artymowicz, RJ Cino, BJ Rossi, JG Walker, JL Moore, S Burdette Tomlin Mem Hosp Dept Pharm Cape May Court Hse NJ 08210 USA Pfizer Pharmaceut Grp Dayton NJ 08810 USA

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华法林相关性肾病研究进展

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国际移植与血液净化杂志 2013年第3期11卷 1-3页

作者：张国庆张玲重庆医科大学附属第二医院肾内科重庆医科大学2011级第二临床学院

自1950年被批准应用于临床后,华法林成为临床最常用、最经典的抗凝药物。华法林在治疗过程中可伴随多种并发症,如出血、过敏、与其他药物发生相互作用等。此外,在华法林的治疗过程中存在一种潜在的并发症,即华法林相关性肾病。华法林相... 详细信息

自1950年被批准应用于临床后,华法林成为临床最常用、最经典的抗凝药物。华法林在治疗过程中可伴随多种并发症,如出血、过敏、与其他药物发生相互作用等。此外,在华法林的治疗过程中存在一种潜在的并发症,即华法林相关性肾病。华法林相关性肾病主要见于患有慢性肾脏疾病的患者,可引起肾功能恶化,死亡风险增高。一、华法林的药理作用华法林是香豆素类口服抗凝药物,主要在肝脏微粒体内抑制维生素K依赖性凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ的合成3。维生素K可促使维生素K依赖性凝血因子

关键词：华法林/副作用肾疾病/化学诱导综述人类

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