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1例75岁女性患者因高血压病和心房颤动遵国外医院医嘱口服美托洛尔(100 mg/早,75 mg/晚)及利伐沙班(20 mg/晚)。1个月后肝功能检查示丙氨酸转氨酶(ALT)90 U/L、γ-谷氨酰转肽酶(γ-GT)133 U/L,且出现视物模糊。停用利伐沙班,次日患者视物模糊症状消失,第3天ALT49 U/L,γ-GT 73 U/L。停用利伐沙班第2天给予华法林(3.0 mg/晚)口服。次日患者出现血尿,急查INR为0.98。患者拒绝继续使用华法林,遂重新减量口服利伐沙班(10 mg/晚,药物自备),并严密监测肝功能和眼部症状。此后ALT及γ-GT水平均基本正常,视物模糊症状未再出现。
A 75-year-old female patient received metoprolol (100 mg / day, 75 mg / night) and rivaroxaban (20 mg / night) orally as prescribed by a foreign hospital for hypertension and atrial fibrillation. Liver function tests at 1 month showed alanine aminotransferase (ALT) of 90 U / L and γ-glutamyl transpeptidase (γ-GT) of 133 U / L with blurred vision. Rivaroxab was discontinued. The second day the patients had blurred vision and symptoms. ALT was 49 U / L on day 3 and 73 U / L on γ-GT. Rivaroxaban was discontinued on the second day with warfarin (3.0 mg / night) orally. The next day, patients with hematuria, acute check INR was 0.98. Patients refused to continue with warfarin, and regained oral rivaroxaban (10 mg / night, drug-provided) and closely monitored liver function and ocular symptoms. After ALT and γ-GT levels were normal, blurred vision symptoms no longer appear.