临床药师基于CYP2C9和VKORC1基因型指导华法林个体化用药

Clinical Pharmacist Participating in Warfarin Individualized Medication under Guidance of CYP2C9 and VKORC1 Gene

目的本文旨在探讨临床药师在华法林剂量调整中的作用。方法临床药师参与1例动静脉内瘘血栓形成患者的治疗工作,从遗传和非遗传因素分析导致华法林维持剂量差异的原因,建议临床医师对患者进行CYP2C9和VKORC1基因型的检测,并根据基因型检测结果调整华法林剂量。结果基因型检测结果提示患者需要较高剂量的华法林才能达到目标值,患者经治疗后病情好转,凝血指标达标后出院。结论华法林的抗凝疗效受很多因素影响,临床药师通过对华法林多个基因的多态性与患者病理生理情况相结合,提高患者用药的有效性和安全性。

OBJECTIVE To explore the role of clinical pharmacist in warfarin dosage adjustments. METHODS Through participating in the treatment for a case of Arteriovenous fistula thrombosis,clinical pharmacist analyzed the cause of the warfarin maintenance dose difference from the genetic and non-genetic factors,suggested clinicians to detect patients CYP2C9 and VKORC1 genotypes,adjusted warfarin dose according to the results of genotype. RESULTS Genotyping results suggested that the patient required higher doses of warfarin in order to achieve the target value. After treatment,the disease condition of the patient was relieved.The patient was discharged from the hospital after coagulation index standard. CONCLUSION The anticoagulation effect of warfarin was affected by many factors, clinical pharmacist combined the genetic polymorphisms of warfarin related genes with patients physiological and pathological situation. The participation of clinical pharmacist can improve drug efficacy and safety.