Iliopsoas Hematoma with Compressive Femoral Neuropathy Complicating Warfarin Prophylaxis: A Case Report

接受心臟金屬瓣膜置換的患者往往需要終身服用抗凝劑，然而服用抗凝劑便有可能有過度抗凝及出血的可能性。病歷報告一位61歲的亞洲男性因非創傷性左側腰痛及左下肢無力被送至急診室，他過去因接受心臟金屬瓣膜置換長期服用香豆素，經電腦斷層及神經學檢查後發現病患罹患骼積血腫合併壓迫性神經病變，凝血功能撿查發現凝血脢原時間及部分凝血脢原時間延長，我們回顧文獻並分析長時服用低劑量香豆素造成國際標準化比值（INR）延長及出血傾向的因素。結論：影響INR的因素很多，既使是服用長期低劑量香豆素仍須定期監測INR以避免香豆素造成過渡抗凝。

關鍵字

血腫；華法林；抗凝血劑；股神經病變；維它命K結抗劑

並列摘要

Patients who have received mechanical heart valves usually have to take lifelong prophylactic anticoagulants. Inattention to treatment with low dose prophylactic anticoagulants may result in over-anticoagulation and increase tile risk of bleeding. A 61-year-old Asian man who had a mechanical heart valve and was receiving warfarin presented in the emergency room with non-traumatic spontaueous left lower back pain and left leg weakness on walking for one day. Abdominal computed tomography imaging and neurological examination confirmed a left iliopsoas hematoma with compressive femoral neuropathy. A coagulation profile showed prolonged prothrombin and partial thrombin times. Prophylactic anticoagulation was immediately suspended and tile patient was treated with an oral pain reliever and intra venous Vitamin K injections. The patient's condition improved after treatment and tile coagulation profile was within tile normal limit s on follow-up, the patient was discharged and periodic assessment of the coagulation profile was arranged. Our case study investigated factors contributing to an increased international normalized ratio (INR) in relation to bleeding in patients on long term, low dose warfarin prophvlaxis. We concluded that periodic INR monitoring is still mandatory to prevent bleeding caused by over-anticoagulation in patients on long term, low- dose warfarin prophylaxis.

並列關鍵字

hematoma ； wafarin ； anticoagulation ； femoral nerve neuropathy ； vitamin K antagonist

國際替代計量

Iliopsoas Hematoma with Compressive Femoral Neuropathy Complicating Warfarin Prophylaxis: A Case Report

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