1例老年心房纤颤行导管消融术患者抗凝治疗分析及药学监护的报道

Anticoagulant therapy analysis and pharmaceutical monitoring in an elderly patient with atrial fibrillation undergoing catheter ablation:a case report

本文从华法林国际标准化比值(INR)波动原因、围术期以及长期抗凝方案的制定、传统口服抗凝药与新型口服抗凝药之间的转换、抗凝药服用注意事项等角度,对1例老年心房纤颤行导管消融术患者的抗凝治疗进行药学监护和指导。通过临床药师积极的药学监护和指导,确保了导管消融术期间无血栓和出血不良事件,同时还将抗凝策略调整为新型口服抗凝药:达比加群,确保了充分的抗凝疗效,同时也降低了出血风险。临床药师协同医护对此类老年患者围术期抗凝予以适当的药学管理,不仅保证了抗凝治疗的合理性,也确保了抗凝的安全性和延续性。

In this paper,one elderly atrial fibrillation patient with anticoagulant therapy undergoing catheter ablation was given pharmacological monitoring and guidance from the causes of Warfarin international standardized ratio(INR)fluctuations,the perioperative period and the formulation of long-term anticoagulation programs,the conversion between traditional oral anticoagulants and new oral anticoagulants,and precautions for taking anticoagulants.Through active pharmacological monitoring and guidance by the clinical pharmacist,there were no thrombotic and hemorrhagic adverse events during catheter ablation,and the anticoagulation strategy was adjusted to a new oral anticoagulant:Dabigatran,to ensure sufficient anticoagulant efficacy and also reduce the risk of bleeding.The clinical pharmacist and the medical care providing proper pharmacological management of perioperative anticoagulation for such elderly patients,not only ensures the rationality of anticoagulation treatment,but also ensures the safety and continuity of anticoagulation.