一例心室附壁血栓合并消化道出血患者的抗栓药物分析

Analysis of Anticoagulant Drugs in A Patient with Ventricular Mural Thrombus Complicated with Gastrointestinal Dleeding

目的根据华法林的用药特点,探讨临床药师在有心室附壁血栓合并消化道出血的病例中用药的指导作用。方法根据临床相关指南和患者的实际情况,结合现有试验方法,监测华法林的代谢基因型。结果病例中的患者的华法林适宜用量为2.354 mg(qd),建议患者初始使用2.25 mg(qd)。结论临床药师在实践中结合药物代谢基因组学的相关知识,才能有效参与合理用药。

OBJECTIVE According to the medication characteristics of warfarin,explore the role of clinical pharmacists in the case of ventricular mural thrombus complicated with gastrointestinal bleeding. METHODS Following the clinical guideline,combined with the real condition of the patient,and tested the genotyping of warfarin. RESULTS Warfarin＇s appropriate dosage of the patient was an initial dose of 2.25 mg orally followed by 2.354 mg oral doses. CONCLUSION The clinical pharmacist can play a role in the rational administration through employing the knowledge of the drug metabolism genomics.