临床药师参与1例结核性胸膜炎合并肺栓塞病例的药物治疗分析

Analysis of Drug Therapy in One Case of Tuberculous Pleurisy Complicated with Pulmonary Embolism by Clinical Pharmacists

对呼吸药学门诊就诊的1例结核性胸膜炎合并肺栓塞患者是否需要继续抗凝以及后续抗凝方案进行分析。患者处于3个月抗凝治疗后的延展期抗凝,由于深静脉血栓(VTE)危险因素未除,且无出血高危因素,建议继续予抗凝治疗。患者同时使用利福平与利伐沙班,利福平通过诱导CYP3A4和P-糖蛋白,可降低利伐沙班血药浓度,但分析患者状况,建议继续使用利伐沙班20mg,po,qd抗凝。1个月后随访,患者病情稳定继续利伐沙班抗凝治疗。

A case of tuberculous pleurisy with pulmonary embolism in the outpatient department of respiratory medicine was analyzed for the need to continue anticoagulation and the follow-up anticoagulation program. In this case, the patient was in the extended anticoagulant period after 3-month anticoagulant treatment, and continued to receive anticoagulant treatment because the risk factors of deep vein thrombosis(VTE) were not removed and there was no high-risk factor of bleeding. Meanwhile, rifampicin was used in combination with rivaroxaban, and rifampicin can reduce the blood concentration of rivaroxaban through induction of CYP3 A4 and P-gp. The reduction of rivaroxaban was not recommended for the time being, and the anticoagulant dose of rivaroxaban 20 mg po qd was recommended to continue to be used. One month later, the patient’s condition was stable, and the above rivaroxaban anticoagulation therapy was continued.