ノート
空腸・回腸切除後の短腸症候群に対してワルファリンで抗凝固療法を行った1例
2019 年 45 巻 7 号 p. 404-408
詳細
2019 年 45 巻 7 号 p. 404-408
Warfarin (WF) has been used for the prevention and treatment of thromboembolism for a long time; however, its use in short bowel syndrome after jejunal and ileal resections has not been reported. We present a case report, which to the best of our knowledge, is the first regarding the treatment of short bowel syndrome after jejunal and ileal total resections using WF.
A 75-year-old man, hospitalized for stroke in 2015, developed an upper mesenteric arterial thrombosis a few days later and underwent resection of the small intestine from the Treitz ligament to the ileum and right colon. He developed cerebral infarction after surgery and was administered heparin sodium injection; however, owing to poor anticoagulation control, WF was added. The patient was administered 1,920 mL to 3,000 mL of ELNEOPA No. 1 injection containing 1,920 µg to 3,000 µg of vitamin K (VK). The WF dose was progressively increased to a daily dose of 10 mg, and the prothrombin time-international normalized ratio (PT-INR) was maintained at 1.5-2.5. The patient was transferred to another hospital on the 134th day.
After initiation of WF, PT-INR was unmeasurable but PT was >180 min on the 16th day, while PT-INR was 6.39 during the dosing period on the 55th day. However, in either case, catheter-related bloodstream infection was suspected, and the central venous catheter was removed. Total parenteral nutrition was modified to peripheral parenteral nutrition. The antagonism of VK and WF was considered to have disappeared, and the PT-INR showed an increase.
