华法林抵抗患者2例及文献分析

Warfarin resistance: case report of 2 patients and the literature analysis

目的:为临床药师发现华法林抵抗患者并参与药学监护提供参考。方法:报道2例华法林抵抗病例,并检索1997—2014年间国内外医药期刊公开报道的华法林抵抗病例,对发生华法林抵抗的原因、人种、最终剂量进行分析。结果:共检索到华法林抵抗病例17例,报道以白种人为主,最大剂量为35 mg·d^(-1),抵抗原因主要包括基因多态性、药物/食物相互作用、吸收障碍。结论:临床药师要注意观察并及时发现华法林抵抗的患者,给予药学监护及处理,并保持长期随访,保证用药安全有效。

Objective： To provide a reference for clinical pharmacists discovering and participating in pharmaceutical care for patients with warfarin resistance. Methods： Two patients with warfarin resistance were reported. The literature of cases reports of warfarin resistance in domestic and international pharmaceutical journals from 1997 to 2014 were retrieved and analyzed. Results： Totally 17 patients were collected; most of them were the white race. The maximum dose used was 35 mg ·d^（-1）. The causes of warfarin resistance included gene polymorphism,drug / food interactions,and malabsorption. Conclusion： Clinical pharmacists should pay attention to and discover the warfarin resistance of patients in time,give them pharmaceutical care and keep long-term follow-up to ensure the safety and effectiveness of the drug.