CAJ | 학술논문

目的：通过分析3例口服华法林后发生急性脑出血患者的临床资料，总结应用华法林导致脑出血的经验和教训，为临床诊治提供参考依据。方法回顾性分析3例华法林相关脑出血患者的临床特征、影像学特点、治疗方法和预后，并结合相关文献复习讨论。结果3例华法林相关脑出血患者中，2例因颅内血肿继续扩大而死亡；1例颅内血肿完全吸收后，继发脑栓塞，头颅CT平扫示右侧枕叶新发梗死灶，住院期间予以重启口服华法林抗凝治疗，调整INR至2~3，病情好转。结论①严格掌握华法林治疗的适应证，定期监测INR；②对于脑栓塞风险较大的华法林相关脑出血患者，评估脑出血风险后尽早重新启动抗凝治疗；③早期纠正INR，可减少血肿扩大。
목적：통과분석3례구복화법림후발생급성뇌출혈환자적림상자료，총결응용화법림도치뇌출혈적경험화교훈，위림상진치제공삼고의거。방법회고성분석3례화법림상관뇌출혈환자적림상특정、영상학특점、치료방법화예후，병결합상관문헌복습토론。결과3례화법림상관뇌출혈환자중，2례인로내혈종계속확대이사망；1례로내혈종완전흡수후，계발뇌전새，두로CT평소시우측침협신발경사조，주원기간여이중계구복화법림항응치료，조정INR지2~3，병정호전。결론①엄격장악화법림치료적괄응증，정기감측INR；②대우뇌전새풍험교대적화법림상관뇌출혈환자，평고뇌출혈풍험후진조중신계동항응치료；③조기규정INR，가감소혈종확대。
Aim To summarize the experience and lessons from the cases and provide valuable references for clinical practice by analyzing the clinical data of three patients who developed acute intracerebral hemorrhage during oral anticoagulation with warfarin. Methods Three patients with warfarin-associated intracerebral hemorrhage were enrolled in our study. Their clinical presentation, imaging features, therapies and outcomes were retrospectively analyzed and discussed with reference to the relevant literature and the date. Results Two of the three patients died because of the intracerebral hematoma expansion. One patient suffered cerebral embolism in the right occipital lobe after intracranial hematoma was completely absorbed. Anticoagulation therapy with warfarin was restarted for this patient during hospitalization with a target INR of 2.0–3.0 and the condition improved gradually. Conclusion ①In order to avoid excessive or insufifcient anticoagulation, the indications for anticoagulation therapy with warfarin should be grasped strictly and international normalized ratio (INR) should be monitored regularly.②Anticoagulation therapy should be restarted as early as possible after estimating the risk of recurrent intracerebral hemorrhage for those patients with high risk of thromboembolism.③It is useful to limit hematoma expansion by correcting.