1例三联抗栓患者出血的药学监护及用药分析

Individualized Pharmaceutical Care and Drug Analysis for One Patient with Hemorrhage after Triple Antithrombotic Therapy

临床药师对1例心源性休克、急性ST段抬高性心肌梗死、房颤,行经皮冠状动脉介入治疗(PCI)后出现消化道出血的患者实施药学监护,关注患者治疗康复过程,协助医师制定用药方案,针对患者消化道出血后抗栓与止血治疗矛盾及时调整用药方案,保障患者药物治疗的安全、有效、经济。本案例为临床药师参与三联抗栓患者的药学监护提供参考。

Clinical pharmacists performed pharmacological monitoring on a patient with cardiogenic shock,acute ST-segment elevation myocardial infarction,atrial fibrillation and gastrointestinal bleeding after PCI. Clinical pharmacists paid attention to the patient’s treatment and rehabilitation process,assisted physicians in developing medication regimen,and adjusted the drug regimen timely for the contradiction between antithrombotic and hemostasis after gastrointestinal bleeding in the patient to guarantee safe,effective,reasonable and economical treatment for the patient. The case provides reference for clinical pharmacists to participate in the pharmaceutical care for triple antithrombotic patients.