临床药师参与抗凝治疗会诊的药学实践与分析

Pharmaceutical practice and analysis of clinical pharmacists participating in anticoagulant therapy consultation

目的探讨临床药师在抗凝治疗会诊中促进合理用药的作用。方法选取4例有代表性的疑难少见会诊病例,重点分析利伐沙班在低蛋白血症患者应用的出血风险,使用华法林的妊娠女性抗凝治疗的调整及监护,颅内静脉血栓、左心耳血栓患者使用直接口服抗凝药(DOACs)的决策。结果临床药师协助临床医生制定个体化抗凝治疗方案并提供药学服务,患者转归良好。结论临床药师参与抗凝治疗会诊对抗凝药物的合理使用具有重要作用。

Objective To explore the role of clinical pharmacists in promoting rational drug use in anticoagulant therapy consultations.Methods Four representative cases of difficult and rare consultation were selected to analyze the bleeding risk of rivaroxaban in patients with hypoproteinemia,the adjustment and monitoring of anticoagulant therapy in pregnant women using warfarin,and the strategy of patients using DOACs for cerebral venous thrombosis and left atrial appendage thrombosis.Results Clinical pharmacists assisted clinicians in formulating individualized anticoagulation treatment programs and provided pharmaceutical care,and the patients recovered well.Conclusion The participation of clinical pharmacists in the consultation of anticoagulant therapy plays an important role in the rational use of anticoagulant drugs.