1例抗布鲁氏菌感染治疗药物致华法林抗凝作用减弱的药学监护

Pharmaceutical care for 1 case of reduced anticoagulation effect of warfarin due to treatment for anti-brucella infection

华法林目前仍是人工心脏瓣膜置换术后患者的口服抗凝药物,在长期治疗过程中其抗凝作用易受到其他疾病、药物等因素的影响。本文通过1例二尖瓣置换术后患者抗布鲁氏菌感染的治疗实践,对患者国际标准化比值(INR)降低的原因展开分析讨论,与临床医师共同制订个体化给药方案,并进行用药宣教,最终患者INR值达标,避免了不良反应的发生。对于多药联合华法林治疗的患者,临床药师对用药过程的全程监护,发现、预防潜在不良反应发生,有利于提高患者药物治疗的安全性和有效性。

Warfarin is the main oral anticoagulant for patients with artificial heart valve replacement. In the long treatment time, the anticoagulation effect may inevitably be affected by other diseases or drugs. In this paper, treatment of anti-brucella infection in one patient after mitral valve replacement was analyzed, to discuss the reasons for the decrease in international normalized ratio. We set up individualized drug regimen with doctors, provided medication education, and the ratio reached the reasonable standard finally. Adverse reactions were avoided. For patients treated with multiple drugs combined with warfarin, clinical pharmacists monitor the whole medication process, and prevent potential adverse reactions, which helps improve the safety and effectiveness of drug therapy.