항혈전제 증량 후 비출혈이 발생한 심장탓 색전성 뇌졸중 환자에 대한 한약 치험 1례

Abstract

Background: Antithrombotic agents are essential for preventing and managing thromboembolic diseases. However, their use often causes hemorrhage. Epistaxis is a common adverse event that reduce medication adherence and quality of life. Despite its significance, effective strategies for managing epistaxis without interrupting antithrombotic therapy remain limited. Case presentation: This case involves a 79-year-old woman with cardioembolic stroke, atrial fibrillation, deep vein thrombosis, and coronary artery disease presented with recurrent epistaxis following dose escalation of apixaban and switch from clopidogrel to aspirin. Despite local hemostatic interventions, bleeding episodes persisted with decreased appetite and sleep disturbances, significantly affecting daily life. During hospitalization, the patient received Chilsaeng-tang and Hwangnyeonhaedok-tang tablets without adjustments to antithrombotic regimen. After 34 days of treatment, epistaxis resolved completely. Furthermore, scores on the Epistaxis Severity Scale-modified, Numeric Rating Scale for discomfort, and EuroQol 5-Dimension 5-Level showed meaningful improvement. Conclusion: This case suggests herbal medicine may provide beneficial complementary treatment for managing epistaxis in patients receiving antithrombotic agents without requiring modification of therapy. Further controlled studies are needed to assess efficacy, safety, pharmacological mechanisms, and potential herb-drug interactions.