1例服用华法林抗凝治疗患者INR异常波动的病例分析

Analysis of One Case of Abnormal INR Fluctuation During Warfarin Anticoagulant Therapy

为探讨临床药师参长期接受口服抗凝药物治疗患者治疗的药学服务方法,及时发现潜在的治疗风险,通过了解1例住院期间发生出血的二尖瓣置换术后合并房颤患者的病史、实验室相关检查、治疗经过,分析该患者出血的原因为可能华法林与胺碘酮联合使用出现药物不良反应。并对患者的抗凝方案进行调整,患者出血情况得到控制。临床药师在临床抗凝治疗团队中发挥了药学服务作用,促进临床安全合理制定抗凝治疗方案。

To improve the recognition of bleeding risk in anticoagulant process by analyzing the abnormal fluctuation of INR during anticoagulant therapy in patients with atrial fibrillation after mitral valve replacement. The possible causes of the abnormal fluctuation of INR were analyzed after the brief introduction of medical history,lab test report and treatment process of the patient. The reason might be the combination of warfarin and amiodarone,and the anticoagulant regimen was adjusted resulting in effective bleeding control. Clinical concomitant drug use should be more careful in patients undergoing long-term anticoagulation therapy. Clinical pharmacist can carry out pharmaceutical service in anticoagulation team in order to promote the performance of rational anticoagulation regimen.