非ST段抬高型急性冠状动脉综合征合并消化道出血患者止血和抗血小板药物治疗方案分析

A hemostatic and antiplatelet pharmacotherapeatic scheme analysis of non-ST-segment elevation acute coronary syndrome with gastrointestinal bleeding

目的分析非ST段抬高型急性冠状动脉综合征(ACS)合并消化道出血患者止血和抗血小板药物治疗方案。方法针对2017年3月18日入住四川省眉山市中医医院非ST段抬高型ACS合并消化道出血1例患者,分析患者一般情况,并进行止血和抗血小板药物治疗,临床药师协助医师分析止血和抗血小板药物治疗方案,随时调整止血和抗血小板药物治疗方案。同时结合文献讨论分析。结果临床药师协助医师分析建议:①停用抗凝药物,避免使用作用于凝血因子的止血药物(氨甲环酸、氨甲苯酸)和强烈缩血管药垂体后叶素(加重心脏缺血)以及酚妥拉明(心肌梗死患者禁用);②使用卡络磺钠、硝普钠、生长抑素;③待胃肠道出血停止后可加用低分子肝素抗凝治疗。此例患者于4月13日病情好转(出血控制、心功能稳定),要求出院。结论临床药师参与"存在治疗矛盾患者"药物治疗方案,不断评估患者获益/风险比,优化不同时机药物方案,能提高临床药物治疗的有效性和安全性。

Objective To analyze the effect of hemostatic and antiplatelet treatment on non-ST-segment elevation acute coronary syndrome （ACS） complicated with gastrointestinal bleeding. Methods One non-ST-elevation ACS patient with gastrointestinal bleeding who was admitted in Meishan Hospital of Traditional Chinese Medicine on March 18, 2017 was analyzed. The patient was treated by hemostatic and antiplatelet drugs, the therapeutic scheme was evaluated by clinical pharmacists and adjusted according to the condition of patient. Results Drug therapeutic schemes suggested by pharmacists Were as follows： （1）Discontinue anticoagulants and avoid hemostatic drugs such as tranexamic acid and tranexamic acid that have effects on blood coagulation factors; avoid vasoconstrictor pituitrin and phentolamine. （2）Carbazochrome sodium sulfonate, sodium nitroprussiate and somatostatin should be used. （3）Low molecular heparin should be used when gastrointestinal bleeding was alleviated. The patient was improved and discharged on April 13th. Conclusion Clinical pharmacists should evaluate the benefit/risk ratio of pharmacotherapeutic scheme and optimize the timing of administration to improve safety and effectiveness of medication for diseases with drug contradiction.