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华法林致深静脉血栓合并急性肾功能不全患者中毒性表皮坏死

松解症的药学监护
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施 超 ，舒德忠（重庆大学附属涪陵医院药学部，重庆 408000）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2025）18-2317-05
DOI 10.6039/j.issn.1001-0408.2025.18.18

摘 要 目的 为深静脉血栓合并急性肾功能不全患者使用华法林后出现中毒性表皮坏死松解症（TEN）的药学监护提供参考。
方法 临床药师参与1例深静脉血栓合并急性肾功能不全患者服用华法林后出现TEN的药学监护过程。临床药师根据Naranjo’s
评估量表、国家药品不良反应监测中心不良反应因果关系判断标准判定该患者发生的 TEN 与华法林的关联性均为“很可能”；
TEN评分（SCORTEN）为3分。针对患者出现的TEN，临床药师建议停用华法林，加强抗过敏处理，请烧伤整形外科协助诊治，同
时加强监测；患者肾功能恢复后，建议将肝素更换为利伐沙班；患者感染控制后，建议停用抗感染药物。结果 医师采纳临床药师
建议。患者经治疗后好转，准予带药出院，出院后随访未再发生类似反应。结论 华法林致深静脉血栓合并急性肾功能不全患者
的TEN较为罕见，其机制不明确。临床应用华法林时需加强监测血常规、凝血图、肾功能、炎症指标；一旦怀疑为TEN，应立即停
药并给予抗过敏等对症治疗，同时通过加强临床药师与临床医师的沟通、完善患者随访、优化治疗方案等，确保患者的用药安全。
关键词 华法林；中毒性表皮坏死松解症；深静脉血栓；药品不良反应；临床药师

Pharmaceutical care for toxic epidermal necrolysis in patients with deep vein thrombosis and acute renal
insufficiency induced by warfarin
SHI Chao，SHU Dezhong（Dept. of Pharmacy， Fuling Hospital Affiliated to Chongqing University， Chongqing
408000， China）

ABSTRACT OBJECTIVE To provide a reference for pharmaceutical care of patients with deep vein thrombosis and acute renal

insufficiency that develop toxic epidermal necrolysis （TEN） after taking warfarin in clinical practice. METHODS Clinical
pharmacists participated in the pharmaceutical care for a patient with deep vein thrombosis and acute renal insufficiency that
developed TEN after taking warfarin. Based on the Naranjo’s assessment scale and the causality judgment criteria of the National
Center for Adverse Drug Reaction Monitoring， the clinical pharmacists determined that the association between TEN and warfarin
was “probable”. The TEN score （SCORTEN） was 3. Regarding the TEN that occurred in the patient， the clinical pharmacists
recommended discontinuing warfarin， strengthening anti-allergic treatment， requesting assistance from the burn and plastic surgery
department for diagnosis and treatment， and strengthening monitoring. When the patient’s renal function gradually recovered， it
was recommended to replace heparin with rivaroxaban. After the infection was controlled， the anti-infective drug withdrawal was
suggested. RESULTS The physician adopted the clinical pharmacist’s suggestions. The patient improved after treatment， was
allowed to be discharged with medication， and no similar reactions recurred during follow-up after discharge. CONCLUSIONS The
occurrence of TEN caused by warfarin in patients with deep vein thrombosis and acute renal insufficiency is relatively rare. The
mechanism is unclear. During clinical application， it is necessary to strengthen monitoring of blood routine， coagulation profile，
renal function， and inflammatory indicators. If TEN is suspected， the drug should be immediately discontinued， and symptomatic
treatment， such as anti-allergic treatment should be given. Communication of clinical pharmacists with the physicians should be
strengthened， patient follow-up should be improved， and the drug treatment plan should be optimized to ensure the safety of the
patient’s medication.
KEYWORDS warfarin； toxic epidermal necrolysis； deep
Δ 基金项目 重庆市临床药学重点专科建设项目（No. 渝卫办发
vein thrombosis； adverse drug reactions； clinical pharmacist
〔2023〕69号）
＊第一作者 主管药师。研究方向：血栓性疾病的治疗与监护、药
品不良反应监测。E-mail：328962654@qq.com
深静脉血栓是指血液在深静脉异常凝结形成的血
# 通信作者 主任药师，硕士。研究方向：药事管理、临床药学。
E-mail：406643503@qq.com 栓，多见于下肢（如股静脉、腘静脉），可导致肺栓塞等严

中国药房 2025年第36卷第18期 China Pharmacy 2025 Vol. 36 No. 18 · 2317 ·