[Pharmaceutical care for a patient with warfarin-induced autoimmune hepatitis]

Here we reported a patient with warfarin-induced autoimmune hepatitis (AIH), and explored new concerns for the pharmaceutical care of warfarin. A 57- year-old woman was admitted to hospital for repeated anorexia, abdominal pain and abnormal liver function. She received prosthetic heart valve replacement because of rheumatic heart disease, and had started warfarin medication since 2 years before. Her liver function was elevated with highest alanine aminotransferase 861 U/L, aspertate aminotransferase 604 U/L, and total bilirubin 106.7 μmol/L. Her anticoagulant therapy was switched to low molecular weight heparin and the liver function returned to normal. The liver function was elevated when she started to take warfarin again. The patient was then on liver protection therapy, and warfarin was stopped again for the liver biopsy for diagnosis reason. Through medication consultation and evaluation, pharmacists were invited to work together with the physicians and helped to differentiate the reason for abnormal liver function, and provided therapeutic suggestions. Also the pharmacists gained experiences in the treatment of AIH, and discovered a new and severe adverse drug reaction for warfarin. In treating this case, the pharmacists'active involvement into the treatment and evaluation of the effect on the patient reflected the advantage and importance of the multidisciplinary cooperation for pharmacists and physicians when complex diseases are faced.