北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (5): 809-813.

• 病例报告 • 上一篇    下一篇

华法林与曲马多相互作用致严重出血的药学监护1例报道

董淑杰1,2,张婷1,李彦1,2,翟所迪1△   

  1. (1. 北京大学第三医院药剂科,北京100191;2. 北京大学医学部药事管理与临床药学系,北京100191)
  • 出版日期:2014-10-18 发布日期:2014-10-18

Pharmaceutical care of serious bleeding induced by tramadol-warfarin interaction: a case report

DONG Shu-jie1,2, ZHANG Ting1, LI Yan1,2, ZHAI Suo-di1△   

  1. (1. Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; 2. Department of Pharmaceutical Administration and Clinical Pharmacy, Peking University, Beijing 100191, China)
  • Online:2014-10-18 Published:2014-10-18

关键词: 华法林, 曲马多, 出血, 药学监护

Abstract: Warfarin is a high-alert medication, which may result in bleeding if used improperly. In our case, one elderly female with atrial fibrillation had taken warfarin for more than half a year, and her international normalized ratio (INR) was maintained within the therapeutic range. The patient began to take tramadol to alleviate her shoulder pain. Three days later she presented hematuresis and had ecchymosis in her right upper arm, and in the meantime her INR rose to 10.04. Clinical pharmacists analyzed the cause for bleeding by searching relevant literature, and finally discovered the interaction between warfarin and tramadol. On the basis of that, the clinical pharmacists provided pharmaceutical care, offered specific medication education, as well as assisted the physicians to establish the medication plan for warfarin reuse. Eventually, her INR declined to reference ranges, and her hematuresis and ecchymosis were alleviated significantly. This successful case reveals that clinical pharmacy services contribute to better treatment outcomes. Clinical pharmacists can play an active role in anticoagulation management in healthcare team.

Key words: Warfarin, Tramadol, Hemorrhage, Pharmaceutical care

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