临床药师参与1例心房颤动合并多种疾病患者国际标准化比值异常升高后的药学监护

Participation of clinical pharmacist in the pharmaceutical monitoring of a patient with atrial fibrillation complicated with multiple diseases and abnormal increasing international normalized ratio

目的:分析1例长期使用华法林的心房颤动合并多种疾病患者在住院期间国际标准化比值(international normalized ratio, INR)异常升高的原因,促进临床合理用药。方法:从患者病理生理学因素和药物两方面探讨导致患者INR升高的原因。结果:华法林的抗凝效果受多种因素影响,包括发热、血浆白蛋白水平降低、肾功能不全和合并使用其他药物等。结论:对使用华法林治疗的心房颤动合并多种疾病患者,临床药师应进行实时药学监护,配合临床医师做到统筹兼顾。

Objective: To analyze the cause of an abnormal increasing in international normalized ratio(INR) of a patient with atrial fibrillation complicated with multiple diseases during hospitalization, who has been treated with warfarin for long time and to promote clinical rational drug use.Methods: The causes of increased INR in this patient were discussed from two aspects: pathophysiological factors and drugs.Results: The anticoagulant effect of warfarin would be affected by many factors including fever, decreased plasma albumin level, renal insufficiency, the combined use of other drugs and so on.Conclusion: Clinical pharmacists should conduct real-time pharmaceutical monitoring and coordinate with clinicians to make overall plans with respect of the warfarin-taking patients with atrial fibrillation complicated with multiple diseases.