1例肺栓塞患者围手术期抗凝药物治疗分析及干预

Medication analysis and intervention on perioperative anticoagulation therapy in a patient with pulmonary embolism

目的:探讨肺栓塞患者在围手术期中抗凝治疗中的药学服务,体现临床药师在围手术期抗凝治疗中的重要作用。方法:临床药师通过对患者进行药学评估,使用Caprini VTE深静脉血栓风险评估模型评价患者术后风险,制定抗凝方案,开展围手术期抗凝治疗监护供药学服务。结果 :临床药师结合药动学知识,制定抗凝方案,最大程度上降低了患者出血和血栓风险。结论:临床药师通过实施药学监护,可明显提升高出血风险患者用药的安全性和治疗有效性,降低抗凝药出血风险,改善患者预后。

Objective： To discuss how to carry out pharmaceutical care to patients with pulmonary embolism in perioperative bridging anticoagulation therapy in order to show the important role of clinical pharmacist in perioperative bridging anticoagulation therapy. Methods： From the aspect of pharmaceutical evaluation, Caprini VTE risk assessment model was used to evaluate the patient＇s post-operative risk, develop anticoagulation strategy and provide pharmaceutical care on anticoagulation therapy. Results： The clinical pharmacists could optimize the anticoagulant regimen by using the pharmacokinetic knowledge to decrease the risk of hemorrhage and embolism to the largest extent. Conclusion： Pharmaceutical care improved safety and efficiency of medicine therapy of pulmonary embolism patients with high bleeding risk, and decreased adverse effects in bleeding, and improved patient＇s prognoses.