LVAD植入术后患者个体化抗凝治疗的药学实践

Pharmaceutical practice of individualized anticoagulant treatment for patients after left ventricular assist device implantation

目的:探讨临床药师在左心室辅助装置植入术后患者个体化抗凝治疗中的作用。方法:临床药师全程参与1例左心室辅助装置植入术后患者的抗凝治疗过程,通过多学科会诊、药物基因检测、用药监护等模式提供个体化、精准化药学服务。结果:临床药师协助医师制定了术后应用华法林长期抗凝的治疗方案,及时关注到围术期华法林与其他药物间相互作用,动态调整华法林剂量以减少INR大幅波动,避免了出血事件的发生。结论:临床药师可积极发挥专业特长协助医师制定和优化患者的治疗方案,保障患者用药安全有效。

Objective:To investigate the role of clinical pharmacists in the individualized anticoagulant therapy of a patient with left ventricular assist device(LVAD) implantation.Methods:Clinical pharmacists participated in the whole process of anticoagulant therapy for the patient and provided individualized and precise pharmaceutical care by multidisciplinary consultation,drug gene testing and drug monitoring.Results:Clinical pharmacists assisted physicians in formulating long-term anticoagulant treatment of warfarin,paying attention to the interaction between warfarin and other drugs during perioperative period,and dynamically adjusting warfarin dose to reduce large fluctuations in INR and avoid bleeding events.Conclusion:Clinical pharmacists can actively use their professional expertise to assist physicians in formulating and optimizing treatment plans for patients,so as to ensure safe and effective medication for patients.