Abstract:

Objective　To investigate the clinical characteristics and therapeutic effect of acquired vitamin K dependent coagulation factor deficiency caused by coumarins including overdosage of warfarin and rodenticide poisoning. Methods　The clinical data of 61 patients diagnosed in Department of Hematology, Donghai Branch, The Second Affiliated Hospital of Fujian Medical University from July 2013 to July 2022 were retrospectively analyzed. According to the type of coumarins, they were divided into group A (overdosage of warfarin, 34 cases) and group B (rodenticide poisoning, 27 cases). There were 19 males and 15 females in group A, aged 32-82 years, with a median age of 71 years old; in group B, there were 15 males and 12 females, aged 19-88 years, with a median age of 53 years old. The patients with severe bleeding symptom were given intravenous infusion of vitamin K₁ 10-60 mg/d supplemented with infusion of fresh frozen plasma. The changes of prothrombin time (PT) and activated partial thromboplastin time (APTT) before and after treatment and the detoxification time of vitamin K₁ were detected. t test was used. Results　The patients with overdosage of warfarin and bleeding in group A showed PT (111.58±46.50) s and APTT (100.02±20.58) s before vitamin K₁ treatment, and PT (17.13±4.30) s and APTT (37.77±58.91) s after vitamin K₁ treatment, with statistically significant differences (both P<0.01); warfarin should be suspended only in patients without bleeding. The patients with rodenticide poisoning in group B showed PT (102.13±75.34) s and APTT (84.02±48.24) s before vitamin K₁ treatment, and PT (17.39±4.43) s and APTT (33.03±7.78) s after vitamin K₁ treatment, with statistically significant differences (both P<0.01). The detoxification time of vitamin K₁ in patients with overdosage of warfarin and bleeding was 1 day, and 1 month to 1 year in patients with rodenticide poisoning, and the detoxification time of vitamin K₁ was different between the two (P<0.01). Conclusions　Warfarin and rodenticide are coumarin anticoagulants. Vitamin K₁ is effective in the treatment of overdose of warfarin or rodenticide poisoning. Because the purpose and half-life of the two drugs are different, the detoxification methods after overdose are not the same.

Key words: Coumarins, Acquired vitamin K dependent coagulation factor deficiency, Warfarin, Rodenticide, Vitamin K₁, Prothrombin time, Activated partial thromboplastin time

摘要：

目的　探讨香豆素类（包括华法林过量和毒鼠药中毒）相关获得性维生素K依赖性凝血因子缺乏症的临床特点和治疗效果。方法　回顾性分析2013年7月至2022年7月福建医科大学附属第二医院东海院区血液科诊治的61例患者临床资料，根据香豆素类类型分为A组（华法林过量，34例）和B组（香豆素类鼠药中毒，27例）。A组男19例、女15例，年龄32～82岁（中位年龄71岁）；B组男15例、女12例，年龄19～88岁（中位年龄53岁）。出血症状严重者给予静脉滴注维生素K₁ 10～60 mg/d，辅以输注新鲜冰冻血浆。比较治疗前后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）变化及维生素K₁解毒时间。采用t检验。结果　A组华法林过量伴出血表现患者维生素K₁治疗前PT［（111.58±46.50）s］、APTT［（100.02±20.58）s］与治疗后PT［（17.13±4.30）s］、APTT［（37.77±58.91）s］比较，差异均有统计学意义（均P<0.01）；华法林过量无出血表现患者仅需暂停华法林。B组香豆素类鼠药中毒患者维生素K₁治疗前PT［（102.13±75.34）s］、APTT［（84.02±48.24）s］与治疗后PT［（17.39±4.43）s］、APTT［（33.03±7.78）s］比较，差异均有统计学意义（均P<0.01）。华法林过量伴出血表现患者维生素K₁解毒时间1 d，香豆素类鼠药中毒患者维生素K₁解毒时间1个月至1年，两者维生素K₁解毒时间不同（P<0.01）。结论　华法林、香豆素类鼠药均属于香豆素类抗凝剂，其用药过量或中毒，维生素K₁治疗均有效；因为2种药物使用目的及半衰期不同，故两者过量后的解毒方式不尽相同。

关键词: 香豆素类, 获得性维生素K依赖性凝血因子缺乏症, 华法林, 毒鼠药, 维生素K₁, 凝血酶原时间, 活化部分凝血活酶时间