PCI术后急性期颅内出血患者的抗栓药物药物调整及药学监护

Antithrombotic Drug Adjustment and Pharmaceutical Care for a Patient with Cerebral Hemorrhage in the Acute Period of PCI

探讨临床药师在经皮冠状动脉介入治疗(PCI)术后急性期颅内出血患者个体化抗栓药物治疗中的作用。临床药师参与1例不稳定型心绞痛患者的治疗过程,通过综合分析其病变复杂程度、颅内出血发生时间、植入支架数量、出血危险因子等因素,建议查血栓弹力图(TEG)进行分析,用以调整抗栓药物方案。并行疗效评价、不良反应监测等药学监护以及用药注意事项、饮食调整等用药教育。医师采纳临床药师建议,患者病情好转出院。患者出院后,仍坚持使用阿司匹林+氯吡格雷双联抗血小板治疗,病情稳定采用TEG可以及时发现患者对抗血小板药物敏感性,从而可以对介入术后患者制定个体化的抗栓方案。

To explore the role of clinical pharmacists in the adjustment of individual antithrombotic drugs for patients with acute intracranial hemorrhage after percutaneous coronary intervention(PCI).Clinical pharmacists involved in the treatment of a patient with unstable angina pectoris.According to the comprehensive analysis of the pathological complexity,the time of intracranial hemorrhage,the number of stents implanted,the bleeding risk factors and the other factors,clinical pharmacists suggested to detect the thrombelastography(TEG)in order to adjust the antithrombotic drugs.Pharmaceutical care including therapeutic evaluation and ADR monitoring were performed,and medication education such as medication notes and dietary adjustment were also provided.Physicians adopted the suggestions of clinical pharmacists,and the patient recovered and was discharged from hospital.After discharge,the disease condition kept stable with dual antiplatelet therapy by aspirin and clopidogrel.Patient’s sensitivity to platelet drugs can be discovered timely through the TEG,and individulized antithromotic medication can be made for patients after PCI.