| Objective:Warfarin is widely used in primary and secondary prevention of thromboembolic disease,especially in patients after Valve replacement surgery,who need long term anticoagulant therapy by oral Warfarin.Warfarin’s treatment window is narrow,and there were significant individual differences in Warfarin dose.Bleeding was the most common complication of Warfarin,so improper administration of Warfarin could lead to bleeding,thrombosis and other adverse events.It repoted that about 1/3 of women during:reproductive age worldwide suffer from abnormal uterine bleeding[1].About 13%of heavy menstrual bleeding women have coagulopathy[2].Long-term abnormal uterine bleeding not only seriously affects the health of patients,but also causes some patients to have negative mood,mental stress,sexual disharmony,social activity disorder,at the same time brings economic burden to some families,which seriously affects the quality of life of patients.When abnormal uterine bleeding occurs in patients treated with Warfarin’s drugs,excluding the organic lesions and correcting cogulationg the coagulopahthy are both important.In addition to hemostasis,the risk of valve thrombus and valve disfunction should be considered.From January 2013to October 2019,the clinical features of abnormal uterine bleeding in 12 patients with Warfarin were reviewed,which include clinical examination,treatment,follow-up of the patient’s prognosis.By review of the literature,to improve the understanding of such patients,diagnosising in time,giving appropriate intervention and treatment as soon as possible,so as to improve the clinical efficacy and improve the quality of life of patients.Methods:From January 2013 to October 2019,the clinical features of abnormal uterine bleeding in 12 patients with Warfarin were reviewed,which include clinical examination,treatment,follow-up of the patient’s prognosis,and the related literature was reviewed.Resulte:（1）Of the 12 patients,age range from 38 to 54,mean age（45.33±4.64）years old.Menses increased in 2 cases（16.67%）,menses prolonged in 3 cases（25.00%）and both symptoms in 7 cases（58.33%）.Hemoglobin before treating range from 36g/L to 85g/L,mean（57.92±15.47）g/L,including mild anemia in 0 cases,moderate anemia in 4 cases（33.33%）and severe anemia in 8cases（66.67%）.（2）Of the 12 patients,8 patients were given suspended red blood cell transfusion（66.67%）.Three patients（25.00%）with AUB-A,one（8.33%）with AUB-C,one（8.33%）with AUB-P,one（8.33%）with AUB-E,one（8.33%）with AUB-L,and three（25.00%）with AUB-AConclusion:（1）The patients in Perimenopausal with Warfarin occurred abnormal uterine bleeding mainly manifested as increased menstrual volume,prolonged menstrual period or both.Lacking of attention,patients don’t see a doctor until serious..It is necessary to do a good job of education and guidance,to get the patient’s attention.In the diagnosis and treatment of those patients need multi-disciplinary participation.（2）The patients in Perimenopausal with Warfarin occurred abnormal uterine bleeding caused by coagulation problems was less,most of them were accompanied by organic pathological changes of uterus,ovulation obstacle or abnormal endometrium,therefore,the health care of perimenopausal women can not be ignored.（3）When AUB patients using warfarin after valve replacement fail to respond to medical treatment and have no fertility requirement,the first recommendation is to perform endometrial ablation.For patients who must undergo total hysterectomy,multidisciplinary assessment and control of INR is needed before surgery,in the operation,not only the experienced chief surgeon but also the multi-disciplinary support is needed. |
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