Repeated Intracerebral Hemorrhage after Warfarin Therapy for Atrial Fibrillation: A Case Report

心房顫動使用Warfarin發生連續性腦內出血：案例報告

10.30035/TCCM.201003.0012

楊之東(Chih-Dong Yang)；吳清平(Chin-Pyng Wu)

中風 ； 心房顫動 ； 維他命K擷抗劑 ； 腦內出血 ； Stroke ； Atrial fibrillation ； Vitamin K antagonist ； Intracerebral hemorrhage

重症醫學雜誌

11卷1期（2010 / 03 / 01）

73 - 79

英文

心房顫動病人的中風預防已經在很多文獻上被確認其重要性，很多臨床試驗也顯示使用維他命K阻斷劑顯著的減少中風發生。但是使用抗凝血劑可能造成其他併發症，尤其是增加出血機率。我們報告一位六十七歲心房顫動病人使用warfarin後，先發生右腦腦內出血，在給予緊急開顱手術摘除腦內血腫時，另外發生新的腦幹出血，最後不治死亡的案例。我們建議即使warfarin劑量很低，也要嚴密監控及調整抗凝血劑的劑量。

Stroke prophylaxis in patients with atrial fibrillation (AF) has been examined extensively in randomized trials, metaanalyses, and review articles. The clinical trials show that treatment with vitamin K antagonists significantly decreases the risk of stroke in AF patients. However oral anticoagulant use has a greater likelihood of complications, especially increasing the bleeding. We reported a 67-year-old man of atrial fibrillation treated with warfarin who developed right intracerebral hemorrhage (ICH) first. Craniotomy was given due to increased intracranial pressure (IICP). Another ICH over brainstem occurred during craniotomy for the first right ICH, no further operation was given, and the patient expired 4 days later. We suggest considerable dose adjusting of warfarin is required to keep patients within the therapeutic range, even the dose of warfarin is very low.