A 77-year-old female patient with atrial fibrillation took warfarin regularly (2.5 mg once daily for 17 months). During the medication, the results of INR reached the standard and were steady. A week ago, the patient felt pain in lower limbs, and was diagnosed with vasculitis by traditional Chinese medicine department and took decoction of traditional Chinese medicine. On the sixth day, the patient found multiple ecchymosis on her arms, waist and legs. On the seventh day, the patient was admitted to hospital because of the worsening of the ecchymosis. The INR increased to 7.35. Warfarin and the traditional Chinese medicine were withdrawn immediately, meanwhile, the vitamin K1was injected for reversing the anticoagulant effect of warfarin. Three days later, the INR decreased to 1.58, and warfarin (2.5 mg daily) was taken. Twelve days later, the area of ecchymosis reduced by half, and the INR was 2.25. The results of the follow-up visit by clinical pharmacists showed that the ecchymosis disappeared completely and the INRs were 2.45 and 2.21 in one week and two weeks after discharge, respectively.%1例77岁女性房颤患者规律服用华法林钠片(2.5 mg,qd,共17个月),服药期间INR稳定且达标.1周前患者因下肢疼痛于中医科诊断为脉管炎,并服用中药汤剂,服药第6天双侧臂部、腰部、双腿皮肤多处瘀斑瘀点,第7天进展为多处大面积瘀斑,立即入院,查INR 7.35,停用华法林钠片与中药汤剂,给予维生素K1逆转华法林抗凝,3 d后INR降至1.58,重新服用华法林钠2.5 mg·d-1,12 d后大面积瘀斑明显见吸收,面积缩小一半,予以出院,INR 2.25.出院一周后及两周后随访,患者INR分别为2.45、2.21,瘀斑基本吸收完全.
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