1例心房颤动伴多器官功能不全患者抗凝治疗的用药分析

Pharmaceutical Care of Warfarin Anticoagulant Therapy for an Auricular Fibrillation Patient with Multiple Organ Dysfunction

1例74岁心房颤动伴多器官功能不全患者,其住院期间的抗凝治疗出现两次INR(3.69、8.77)超过目标范围。药师分析可能与苯溴马隆、哌拉西林他唑巴坦、头孢哌酮舒巴坦和螺内酯的使用及心、肾、肝功能不全有关,建议调整抗凝治疗方案并最终选择阿司匹林抗栓治疗后起效。

A 74 years old auricular fibrillation patient with multiple organ dysfunction, experienced INR（3.69 and 8.77） exceeding target scope for twice, at the time of hospitalization. Considering possible druginteractions with benzbromarone, piperacillin/tazobactam, sulbactam/cefopcrazone and spirolactone, as well asthe patient＇s heart, liver and kidney dysfunction, pharmacists provided physicians with reasonable advicesand finally chose aspirin for antithrombotic therapy.