1例房颤合并糖尿病患者抗凝治疗的病例分析

Analysis of Anticoagulant Therapy of One Case of Atrial Fibrillation Combined with Diabetes Mellitus

目的探讨临床药师在房颤患者个体化抗凝治疗与用药监护中的工作要点。方法参与心内科1例老年非瓣膜病房颤合并糖尿病患者预防栓塞并发症的华法林抗凝治疗用药方案的制订与用药监护。结果确定符合患者特点的抗凝强度,华法林和肝素的配合方法,通过临床药师的用药教育提高患者自我监测和对影响因素的关注。结论个体化用药方案的设计与分析及用药监护是临床药师开展药学服务工作的切入点。

OBJECTIVE To explore the key points of work for clinical pharmacists in individualized anticoagulant therapy in patients with atrial fibrillation. METHODS The pharmacists participated in the development of the regimen of warfarin anticoagulation and its supervision for prevention of embolism complications in one case of aged patient with non valvular disease combined with diabetes. RESULTS The anticoagulant intensity and the combination regiment of warfarin with heparin were determined according to the characteristics of the patient. Patient self-monitoring and awareness of influencing factors were improved through the medical education by clinical pharmacists. CONCLUSION Design of individualized medication regimen and medication supervision should be the breakthrough point of clinical pharmacists.