目的 各种糖尿病药物层出不穷,与华法林联用发生药物相互作用是临床药师需关注的,艾塞那肽作为新型降糖药,与华法林联用的报道少,本研究拟探讨二者之间相互作用及可能机制,指导患者合理和个体化用药。方法 通过对一例糖尿病合并房颤患者联用华法林与艾塞那肽进行病例分析,介绍艾塞那肽作为新型2型糖尿病药物的特点,并分析艾塞那肽与华法林的相互作用。结果 患者使用艾塞那肽后INR值从2.13降至1.57,艾塞那肽加量后INR值降至1.43,停药后INR值呈上升趋势,出院时INR值1.78。出院后随访INR值已经恢复至2~3。结论 房颤时血液易在心房内淤积而形成血栓,糖尿病患者高凝状态发生血栓的危险性增加,临床上糖尿病合并房颤患者比例大。华法林是目前应用最广泛的口服抗凝药之一,影响因素较多,使用时需要监测凝血酶原时间国际标准化比值(INR)。艾塞那肽因减缓胃排空从而影响华法林的吸收导致INR值降低,两药联用时应密切监测INR值,及时调整华法林剂量。
Abstract
OBJECTIVE Blood tends to deposit in atrium to form thrombus in patients with atrial fibrillation. Patients with diabetes are in high coagulation state, for whom thrombosis is easy to occur. The number of diabetic patients with atrial fibrillation is large. Warfarin is one of the most widely used oral anticoagulants, which can cause major or fatal bleeding, so it is necessary to perform regular monitoring of international normalized ratio (INR) on all patients treated with warfarin. New kinds of antidiabetic drugs are widely used in clinic, among which a lot affect INR levels achieved with warfarin therapy. Clinical pharmacists should pay attention to drug interactions and monitor adverse drug reactions. As a new antidiabetic drug, exenatide has less reports of interaction with warfarin. The characteristic of the interaction between exenatide and warfarin was investigated, with the aim to optimize the rational and individualized medication. METHODS A case was introduced in which exenatide was administrated combined with warfarin, so that the possible mechanism of exenatide affecting to warfarin were analyzed. RESULTS INR declined from 2.13 to 1.57 after exenatide being added, and decreased further to 1.43 with concurrency of the increasing exenatide dose. On the contrary, INR was on rise as result of discontinuing exenatide. At last, INR returned to 1.78 when the patient discharged. CONCLUSION Exenatide inhibited the absorption of warfarin, which lead to INR decline attributed to its effect of slowing down the gastric emptying. When exenatide and warfarin are combined,the dose of warfarin must be adjusted based on INR under clinical monitoring.
关键词
2型糖尿病 /
艾塞那肽 /
华法林 /
凝血酶原时间国际标准化比值 /
相互作用
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Key words
type 2 diabetes mellitus /
exenatide /
warfarin /
INR monitoring /
interaction
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中图分类号：
R95
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参考文献
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