长期服用华法林患者围手术期抗凝治疗分析及药学监护

The discussion of pharmaceutical care on perioperative management of patients with long-term warfarin treatment

目的探讨临床药师在长期服用华法林抗凝患者围手术期的药学服务内容和作用。方法通过对长期服用华法林抗凝患者围手术期出血风险及栓塞风险评估,临床药师帮助临床医师制定规范、合理的个体化抗凝方案,并提出围手术期抗凝治疗的监护重点。结果通过合理、有效的围手术期抗凝治疗,可在不增加栓塞风险的基础上避免围手术期不良出血事件;同时还可通过药物合理选用及剂量调控,积极有效的规避抗凝药物相关的不良反应。结论在长期服用华法林抗凝患者的围手术期治疗中,临床药师应根据患者栓塞及手术风险,从术前评估、是否给予桥接治疗、术后抗凝、抗凝药物选择及剂量等方面,为患者提供个体化的抗凝治疗方面。

Objective To discuss and explore the role of clinic pharmacists in the pharmaceutical care of perioperative management of patients with long - term warfarin treatment. Methods According to the risk assessment of thrombosis and bleeding, the anticoagulant treatment of perioperative care was proposed as well as the key points of pharmaceutical care. Results The efficacy and safety of the patientg perioperative anticoagulation therapy were guaranteed by reasonable choice of drugs ,dosage control and timely pharmaceutical care. With the effective management of perioperative anticoagulant treatment, the severe bleeding could be avoided without increasing risks of thrombosis. Conclusions Individual pharmaceutical care should be provided on the basis of the risk assessment of thrombosis and bleeding in addition to the patientg individual characteristic. The interruption of VKAs, the bridging antieoagulationtherapy, dosing regimen optimization and the resumption of VKAs could be considered in the perioperative management of patients with long - term anti- coagulation therapy.