临床药师参与一例肝硬化食管静脉出血合并门静脉血栓患者的抗凝治疗并作分析

Analysis of a Case of Anticoagulant Therapy in Alcoholic Liver Cirrhosis Patient with Esophageal Variceal Bleeding Combined with Portal Vein Thrombosis by Clinical Pharmacists

临床药师参与了一例酒精性肝硬化、食管静脉曲张破裂出血合并门静脉血栓患者的治疗过程。即参与患者个体化抗凝治疗方案的制定与用药监护。协助临床医师确定低分子肝素和华法林的治疗方案,对患者进行了用药教育与用药监护,提高了患者用药依从性和安全性。事实证明,个体化用药方案的设计与分析及用药监护是临床药师开展药学服务工作的切入点,有助于患者用药安全,促进临床合理用药。

To explore the key points for clinical pharmacists taking part in clinical medicine treatment in an alcoholic liver cirrhosis patient with esophageal variceal bleeding combined with portal vein thrombosis. The clinical pharmacists participated in the individualized anticoagulant therapy and supervision. Low molecular heparin and warfarin were selected to the therapeutic regimen for this patient according to his characteristics. The patient＇s compliance and safety of medication were improved through medical education by clinical pharmacists. Design of individualized medication regimen and medication supervision should be the pointcut for clinical pharmacists, and all these measures can promise safety of drug use and rationality of clinical medication.