The diagnosis and treatment process of a patient with pulmonary embolism, who developed drug-induced liver injury (DILI) after application of enoxaparin was reported in this paper. The patient was admitted to the hospital with cough, expectoration, chest tightness and shortness of breath, and was diagnosed as acute pulmonary embolism combined with lower extremity venous thrombosis. Based on the initial condition of the patient, 8 000 IU of enoxaparin sodium injection was given subcutaneously every 12 hours for anticoagulation treatment. During treatment, the aminotransferase level of the patient increased, which was considered to be DILI caused by enoxaparin. Then enoxaparin was discontinued and rivaroxaban was used for anticoagulation therapy. After the patient's condition improved, his liver function gradually returned to normal and he was discharged from the hospital. Therefore, timely detection and treatment of DILI in clinical practice can enhance the safety of medication and reduce consequences caused by adverse drug reactions.

1.于乐成,茅益民,陈成伟. 药物性肝损伤诊治指南[J]. 肝脏, 2015, 20(10): 750-767. [Yu LC, Mao YM, Chen CW. Diagnosis and treatment guideline for drug-induced liver injury[J]. Chinese Hepatology, 2015, 20(10): 750-767.] DOI: 10.14000/j.cnki.issn.1008-1704.2015.10.002.

2.Fontana RJ, Liou I, Reuben A, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury[J]. Hepatology, 2023, 77(3): 1036-1065. DOI: 10.1002/hep.32689.

3.孟尧,张萌萌,郭甜甜,等. 《中国药物性肝损伤诊治指南(2023年版)》更新要点解读[J]. 中国肝脏病杂志(电子版), 2023, 15(4): 1-5. [Meng Y, Zhang MM, Guo TT, et al. Interpretation of the updated key points of Chinese guideline for diagnosis and management of drug-induced liver injury (2023 version)[J]. Chinese Journal of Liver Diseases (Electronic Version), 2023, 15(4): 1-5. DOI: 10.3969/j.issn.1674-7380.2023.04.001.

4.王晶,金净进,付伟. 低分子肝素致Ⅳ型药物超敏反应1 例 [J]. 医药导报, 2022, 41(6): 899-900. [Wang J, Jin JJ, Fu  W. One case of type Ⅳ drug hypersensitivity caused by low molecular weight heparin[J]. Herald of Medicine, 2022, 41(6): 899-900.] DOI: 10.3870/j.issn.1004-0781.2022.06.028.

5.姚莉,赵生俊,王丽霞. 临床药师参与1例低分子肝素诱导的血小板降低合并肺栓塞患者的药学监护[J]. 上海医药, 2022, 43(21): 68-71. [Yao L, Zhao SJ, Wang LX. Clinical pharmacists participated in the pharmaceutical care of a patient with low molecular weight heparin-induced thrombocytopenia complicated by pulmonary embolism[J]. Shanghai Medical & Pharmaceutical Journal, 2022, 43(21): 68-71.] DOI: 10.3969/j.issn.1006-1533.2022.21.019.

6.郝坤艳,于乐成,何长伦,等. 基于Roussel uclaf因果关系评估量表的药物性肝损伤140例诊治分析[J]. 中华肝脏病杂志, 2014, 22(12): 938-941. [Hao KY, Yu LC, He CL, et al. RUCAM scale-based diagnosis, clinical features and prognosis of 140 cases of drug-induced liver injury[J]. Chinese Journal of Hepatology, 2014, 22(12): 938-941.] DOI: 10.3760/cma.j.issn.1007-3418.2014.12.012.

7.Harrill AH, Roach J, Fier I, et al. The effects of heparins on the liver: application of mechanistic serum biomarkers in a randomized study in healthy volunteers[J]. Clin Pharmacol Ther, 2012, 92(2): 214-220. DOI: 10.1038/clpt.2012.40.

8.Leo M, Ponziani FR, Nesci A, et al. Low molecular weight heparin as cause of liver injury: case report and literature review[J]. Eur Rev Med Pharmacol Sci, 2019, 23(17): 7649-7654. DOI: 10.26355/eurrev_201909_18888.

9.Levinson P, Glaumann H, Söderberg M. Probable dalteparin-induced hepatotoxicity in a man with alpha-1-antitrypsin deficiency[J]. J Clin Pharmacol, 2012, 52(11): 1764-1767. DOI: 10.1177/0091270011427301.

10.孙丽,高雷,李霖,等. 低分子肝素诱发肝损伤: 个案报道并文献统计分析[J]. 中国现代应用药学, 2023, 40(2): 243-248. [Sun L, Gao L, Li L, et al. Low molecular weight heparin as cause of liver injury: case report and literature review[J]. Chinese Journal of Modern Applied Pharmacy, 2023, 40(2): 243-248.] DOI: 10.13748/j.cnki.issn1007-7693.2023.02.014.

11.Hanni CM, Wilhelm SM, Korkis B, et al. Therapeutic enoxaparin in the morbidly obese patient: a case report and review of the literature[J]. Hosp Pharm, 2019, 54(6): 371-377. DOI: 10.1177/0018578718802839.

12.Mirza R, Nieuwlaat R, López-Núñez JJ, et al. Comparing low-molecular-weight heparin dosing for treatment of venous thromboembolism in patients with obesity (RIETE registry) [J]. Blood Adv, 2020, 4(11): 2460-2467. DOI: 10.1182/bloodadvances.2019001373.

13.LiverTox. Clinical and research information on drug-induced liver injury-low molecular weight heparins[EB/OL]. (2017-11-13) https://www.ncbi.nlm.nih.gov/books/NBK548009/

14.Thompson-Moore NR, Wanat MA, Putney DR, et al. Evaluation and pharmacokinetics of treatment dose enoxaparin in hospitalized patients with morbid obesity[J]. Clin Appl Thromb Hemost, 2015, 21(6): 513-520. DOI: 10.1177/1076029614568713.

15.杨强,刘双,米佳丽,等. 1例碘美普尔肾损伤致依诺肝素严重肝损伤病例的药学实践[J]. 药物流行病学杂志, 2023, 32(7): 836-840. [Yang Q, Liu S, Mi JL, et al. Pharmaceutical practice of one case of severe liver injury caused by enoxaparin due to renal injury caused by iodomepral[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(7): 836-840. DOI: 10.19960/j.issn.1005-0698.202307014.