临床药师参与1例华法林抵抗患者的抗凝治疗实践

发布时间：2019-08-20 17:09

【摘要】：目的:探讨临床药师在心脏瓣膜置换患者华法林个体化抗凝治疗及抗凝管理中的作用。方法:临床药师参与胸心外科1例华法林抵抗患者抗凝治疗用药方案的制订及对患者进行抗凝指导和出院后抗凝随访。结果:临床药师依据基因检测对患者实施个体化抗凝治疗,建议医师将华法林剂量调整为5.625 mg/d,使国际标准化比值达到目标抗凝范围。患者在抗凝期间未发生严重的出血或血栓栓塞等不良事件。患者出院后,临床药师对其进行6个月抗凝随访,调整华法林抗凝方案,并使华法林剂量维持至8.125mg/d。结论:临床药师把握工作切入点,并且通过对患者住院及出院后实施全程化抗凝管理,充分体现临床药师的职业价值,也彰显临床药师在药物治疗团队的作用和地位。
[Abstract]:Objective: to investigate the role of clinical pharmacists in individualized anticoagulant therapy and anticoagulant management in patients with cardiac valve replacement. Methods: the clinical pharmacist was involved in the formulation of anticoagulant therapy in a patient with warfarin resistance in thoracocardiac surgery and the anticoagulant guidance and anticoagulant follow-up after discharge. Results: clinical pharmacists performed individualized anticoagulant therapy on patients according to gene detection. It was suggested that doctors should adjust the dose of warfarin to 5.625 mg/d, to make the international standardized ratio reach the target anticoagulant range. There were no serious adverse events such as bleeding or thrombus embolism during anticoagulation. After discharge from hospital, the clinical pharmacists followed them for 6 months to adjust the anticoagulant regimen of warfarin and maintain the dose of warfarin to 8.125 mg / d. Conclusion: clinical pharmacists grasp the starting point of work, and through the implementation of whole-process anticoagulant management after hospitalization and discharge, they fully reflect the professional value of clinical pharmacists, and also highlight the role and position of clinical pharmacists in drug treatment team.
【作者单位】：皖南医学院弋矶山医院药剂科;皖南医学院弋矶山医院胸心外科;
【基金】：皖南医学院中青年科研基金自然科学类项目(No WK2014F20)
【分类号】：R969.3

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