临床药师参与1例急性肺栓塞抗凝药物治疗的病例分析-现代医学

临床药师参与1例急性肺栓塞抗凝药物治疗的病例分析

单位：1. 徐州医科大学附属宿迁医院药剂处, 江苏宿迁 223800;
2. 南京大学医学院附属鼓楼医院药学部, 江苏南京 210008

分类号：R563.5

出版年·卷·期（页码）：2020·39·第八期（1053-1056）

摘要：

目的：探讨临床药师在急性肺栓塞患者抗凝治疗中的药学作用。方法：临床药师详细了解患者的症状、体征及各项检查结果，结合病情对药物治疗方案进行分析及建议，并进行药学监护。患者肝素钠抗凝的过程中出现了血小板显著降低，考虑发生肝素诱导的血小板减少症（HIT），临床药师建议调整为阿加曲班注射剂抗凝；患者入住ICU后患有急性肾衰竭，后患者肾功能恢复，临床药师建议调整为利伐沙班口服抗凝剂治疗。结果：调整抗凝方案后患者血小板上升，病情好转。结论：患者在使用肝素钠抗凝的过程中出现了血小板显著下降，临床药师配合医师，积极对症处理，根据病情优化方案，保障用药的安全性及有效性。

Objective: To investigate the pharmacological effects of clinical pharmacists in anticoagulant therapy in patients with acute pulmonary embolism.Methods: The clinical pharmacist has a detailed understanding of the symptoms and signs of the patients and the results of each examination. Patients with heparin sodium anticoagulant showed significant decrease in platelets, considering heparin-induced thrombocytopenia (HIT), clinical pharmacists suggested adjusting to Agatraban injection anticoagulant; patients with acute renal failure after admission to ICU then recovered their renal function, clinical pharmacists suggested adjusting to rivastaban oral anticoagulant therapy.Results: After adjusting the anticoagulation regimen, the patient's platelets rose and the condition improved.Conclusion: The platelet decreases significantly in the course of anticoagulant with heparin sodium. The clinical pharmacist should cooperate with the doctor to deal with the disease actively and to ensure the safety and effectiveness of the drug according to the optimized scheme of the disease.

参考文献：

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