1例稳定性冠心病合并房颤及下肢动静脉血栓患者的抗栓实践

Antithrombotic treatment practice in a patient with stable coronary artery disease,atrial fibrillation and lower-extremity arteriovenous thrombosis

1例57岁男性患者,因“反复胸闷气喘9年余,加重1周”入院,入院诊断为慢性心力衰竭急性加重、冠状动脉支架置入后状态、高血压病3级(极高危)、持续性心房颤动、下肢动脉栓塞(右下肢)。入院后积极降压、纠正心衰,并给予抗凝联合抗血小板药物治疗,住院期间结合患者下肢静脉血栓形成、行择期“冠脉支架置入”术等情况,动态评估血栓、缺血与出血风险,及时调整抗栓治疗策略。临床药师全程参与患者治疗,并对患者进行用药指导及药学监护。经治疗患者症状缓解,无出血事件发生,准予出院。2个月后药师随访,患者下肢静脉血栓未进展,病情稳定。

A 57-year-old male patient was hospitalized because of recurrent chest tightness and asthma for more than 9 years and aggravated for 1 week.He was diagnosed with acute exacerbation of chronic heart failure,post coronary stent implantation,hypertension(grade 3,very high-risk),persistent atrial fibrillation,lower-extremity arterial embolism(right lower-extremity).After admission,blood pressure and heart failure were actively corrected,and anticoagulant combined with antiplatelet drugs were given to him at the same time.During hospitalization,the risk of thrombosis,ischemia,and bleeding was dynamically assessed according to the patient’s lower-extremity venous thrombosis and coronary stent implantation,and the antithrombotic treatment plan was adjusted in time.Clinical pharmacists participated in the whole process of the treatment,and provided medication guidance and pharmaceutical care to him.After treatment,the symptoms were relieved without bleeding events and he was successfully discharged.The followed-up after 2 months by clinical pharmacists showed there was no progress of lower extremity venous thrombosis and the patient’s condition was stable.