社團法人臺灣臨床藥學會

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【案例報告】使用低劑量vitamin K改善口服抗凝血劑療效案例報告
維他命K、warfarin、International Normalized Ratios、抗凝血劑、anticoagulants
林嘉音Chia-Yin Lin*1,2 、蘇俊中Jyun-Jhong Su2 、高雅慧Yea-Huei Kao Yang2
1國立成功大學醫學院附設醫院藥劑部 、2國立成功大學醫學院臨床藥學研究所
Warfarin為口服抗凝血劑,用於預防原發性 (primary)或續發性 (secondary)動脈或靜脈血栓的發生及其他導致血栓產生的心血管疾病。雖然大部分病人在密切監測International Normalized Ratios (INRs) 值及調整warfarin劑量下,可減少warfarin相關副作用,仍有少部分病人INRs值難以穩定控制。影響INRs值的因素很多,其一為vitiamin K攝取過少或體內vitamin K不足,所以使用低劑量vitamin K併用warfarin可減少或穩定INRs值波動的情形,降低嚴重warfarin相關之出血風險。
本案例為長期使用warfarin之置換心臟瓣膜的病人,有兩次因服用warfarin而大量出血住院,其INRs值相當不穩定,因此考慮使用低劑量口服vitamin K與warfarin併用來穩定INRs值;兩者併用之後,病人INRs值逐漸趨於穩定。

Oral anticoagulant treatment with vitamin K antagonists is indicated for the primary and secondary prevention of thrombosis resulted from cardiovascular disease. When carefully managed, the complications of anticoagulation could be decreased in most patients. However, INRs remain unstable and fluctuated in some patients despite careful follow-up and dosage adjustment. There are many factors that may influence INRs stability, such as intake insufficiency or lack of body reserves of vitamin K. Daily supplementation of low dose vitamin K together with warfarin would improve stability of INRs, which may further reduce the risk of major bleeding events.
This 73-year-old male has routinely used warfarin since mechanical valve replacement. There were two major bleeding events in our patient lead to hospitalization and his INRs  greatly fluctuated from 2007 to 2008. Therefore, the physician considered to use low dose vitamin K with warfarin to stabilize INRs. And, the INRs become stable in our patient after regimen adjustment.
 
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