An adverse interaction between warfarin and capecitabine: a case report and review of the literature.
An adverse interaction between warfarin and capecitabine: a case report and review of the literature.
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DOI：
10.3816/ccc.2001.n.019
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发表时间：
2001-11-01
影响因子：
3.4
通讯作者：
Chu, E
中科院分区：
文献类型：
--
作者：
Copur, M S;Ledakis, P;Chu, E
华法林是临床上最常用的口服抗凝剂之一。已经确定的是，多种抗凝药物与华法林相互作用，导致凝血参数改变和/或出血后遗症。虽然在口服5-氟尿嘧啶前药卡培他滨联合华法林的患者中观察到凝血参数改变，但迄今为止没有报告描述临床上明显的出血证据。在此，我们报告了2例癌症患者，他们在接受6周的伴随治疗后出现出血事件，最有可能是由于卡培他滨和华法林之间的不良相互作用。在每例病例中，凝血酶原时间和国际标准化比值（> 10）均显著升高，随后发生胃肠道出血。这种相互作用的确切机制尚不清楚，但卡培他滨可能以某种方式降低华法林的肝脏代谢。对于所有接受华法林和卡培他滨合并治疗的患者，建议密切监测凝血参数，并适当调整华法林剂量。这种相互作用的性质和程度需要进一步调查。
Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation.