Objective To learn the antithrombosis management strategy after transcatheter aortic valve implantation (TAVI) and the drug-drug interactions between warfarin and antimicrobial agents based on the real case, and provide a reference for optimizing therapeutic options. Methods We described and analysised a case, and reviewed the relevant literature. Results By reviewing the relevant literatures, combined with clinical experience, warfarin was chosen as the postoperative antithrombotic drug of a patient who accepted TAVI. When warfarin was used in combination with antimicrobials (moxifloxacin, levofloxacin, piperacillin tazobactam, fluconazole), the patient's international normalized ratio (INR) increased to 5.53, which was consistent with conclusions of the literatures. According to the INR values, we timely adjusted the dose of warfarin, and avoided the occurrence of bleeding events. In addition, we educated the patient, once she stopped taking the fluconazole, she needed increasing the dose of warfarin and the frequency of INR monitoring. Conclusion The antithrombosis management strategy after TAVI requires individualization. The effect of the interactions between warfarin and antibacterial agents can be very obvious. Thus, individuals receiving interacting medications are likely to require increased INR monitoring, so as to achieve the best anticoagulant effect and reduce the incidence of adverse reactions.%目的 结合实际案例,了解经导管主动脉瓣置入术(TAVI)治疗后抗栓管理要点及华法林与抗菌药物合用时的相互作用情况,为临床给药方案的优化提供参考.方法 报道、分析1例案例,同时查阅相关文献进行综述讨论.结果通过查阅文献,结合临床经验,该例TAVI患者选择华法林作为术后抗栓药物.华法林在合用抗菌药物(莫西沙星、左氧氟沙星、哌拉西林他唑巴坦、氟康唑)的过程中,患者的INR值升高达5.53,与文献报道相一致,该案例根据INR监测值及时调整华法林的剂量,避免了出血事件的发生,并教育患者出院后在停服氟康唑之后需及时增加华法林剂量及INR监测频率.结论 TAVI 术后的抗栓药物选择常需个体化.华法林与抗菌药物合用时,在启动或者停用抗菌药物时均建议增加 INR 监测频率,及时调整华法林剂量,以达到最佳抗凝效果,减少不良反应发生.
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