Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1087
Peer-review started: June 9, 2020
First decision: November 30, 2020
Revised: December 22, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: February 16, 2021
Processing time: 235 Days and 8.1 Hours
The drug interaction between warfarin and rifampicin is widely known, but there are still some difficulties in managing the combination of the two drugs.
A patient with brucellosis received strict monitoring from a Chinese pharmacist team during combination of warfarin and rifampicin. The dose of warfarin was increased to 350% in 3 mo before reaching the lower international normalized ratio treatment window. No obvious adverse reaction occurred during the drug-adjustment period. This is the first case report of long-term combined use of rifampicin and warfarin in patients with brucellosis and valve replacement in China based on the Chinese lower warfarin dose and international normalized ratio range.
Anticoagulation for valve replacement in Chinese patients differs from that in other races. Establishment of a pharmacist clinic provides vital assistance in warfarin dose adjustment.
Core Tip: Brucellosis is a zoonotic disease with increasing incidence. In order to improve the adherence and cure rate of outpatients, doxorubicin and rifampicin is the preferred treatment. We described a patient with brucellosis and mechanical valve replacement caused by infective endocarditis who required the combination of rifampicin and warfarin. The case highlighted the racial differences in the therapeutic range of the international normalized ratio and the adjustment range of warfarin dose. Individualized medication is required. Pharmacists can help reduce the burden on doctors and the risk of adverse reactions.