循证药学在连续性肾脏替代治疗期间抗凝治疗决策中的应用

Application of Evidence-based Pharmacy in Anticoagulant Treatment Strategies during Continuous Renal Replacement Therapy

目的:探讨循证药学在连续性肾脏替代治疗(CRRT)期间抗凝药物治疗中协助实施最佳治疗方案的作用。方法:以1例患者行CRRT期间出现血小板减少时抗凝药物治疗决策为例,介绍临床药师介入临床,通过循证药学方法结合临床数据,分析高出血风险及血小板减少患者行CRRT期间选用阿加曲班抗凝治疗的证据,并跟踪其疗效和安全性,对药物治疗过程进行综合评估的相关情况。结果:分析检索到高出血风险及血小板减少患者行CRRT期间选用阿加曲班抗凝治疗的文献共5篇,其中有1篇系统评价、1篇随机对照研究、3篇列队研究。将其最佳证据应用到该例患者的临床实践中并取得了较好效果,患者血小板和凝血指标改善,无出血和栓塞并发症发生。结论:循证药学在CRRT期间抗凝治疗决策中可发挥重要作用。

OBJECTIVE： To explore the role of clinical evidence-based pharmacy in anticoagulant treatment strategies during continuous renal replacement therapy （CRRT）. METHODS： Taking a thrombocytopenia patient of anticoagulant treatment during CRRT for instance, clinical pharmacists analyzed the evidence of taken argatroban anticoagulant therapy during CRRT for high risk blooding and thrombocytopenia patients based on evidence-based pharmacy combined with clinical data, monitored the efficacy and safety and evaluated the treatment process. RESULTS：Totally five literature about anticoagulant treatment strategies during CRRT for high risk blooding and thrombocytopenia patients were obtained, including one systematic review, one RCT and three cohort studies. Based on the above evidences, good results were achieved in the clinical practice of this patient, no thrombotic or hemor- rhagic complications occurred in this patient, platelet count and coagulation indicators of patients also improved. CONCLUSIONS： Evidence-based pharmacy plays an important role in anticoagulant treatment strategies during CRRT.