Pharmaceutical care for toxic epidermal necrolysis in patients with deep vein thrombosis and acute renal insuffi-ciency induced by warfarin
- VernacularTitle: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
- Author:
Chao SHI
1
;
Dezhong SHU
1
Author Information
1. Dept. of Pharmacy，Fuling Hospital Affiliated to Chongqing University，Chongqing 408000，China
- Publication Type:Journal Article
- Keywords:
warfarin;
toxic epidermal necrolysis;
deep
- From:
China Pharmacy
2025;36(18):2317-2321
- CountryChina
- Language:Chinese
-
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.
