1例产科抗磷脂综合征并发HELLP综合征患者的抗凝治疗分析与药学监护

Analysis of anticoagulant therapy and pharmaceutical care for a patient with obstetrical antiphospholipid syndrome complicated with HELLP syndrome

1例37岁产科抗磷脂综合征(OAPS)孕妇因“血压控制不佳”入院,入院后血压波动大(152~161/100~112mmHg),血小板计数进行性下降(65×10^(9)·L^(-1)),乳酸脱氢酶367 U·L^(-1),丙氨酸氨基转移酶121.8 U·L^(-1),天冬氨酸氨基转移酶89 U·L^(-1),病情进展为HELLP综合征。临床药师参与其治疗过程,结合患者血栓及出血风险、血小板动态变化、抗凝药物药代动力学特征,协助临床医师制定其围产期个体化抗凝治疗方案,及时停用及启用抗凝药物,有效避免了患者血栓和产后出血并发症的发生。同时以循证药学为基础,分析了此类患者妊娠期和哺乳期的药学监护要点,羟氯喹、阿司匹林、泼尼松等OAPS常规用药在妊娠期规范化使用利大于弊,但需密切监护相应的不良反应,依诺肝素无乳汁蓄积,可在哺乳期安全使用,临床药师在保障妊娠与哺乳期患者用药安全有效中发挥重要作用。

A 37-year-old woman with obstetric antiphospholipid syndrome(OAPS)was admitted to hospital due to poorly controlled hypertensive.After admission,the patient's blood pressure fluctuated greatly(152-161/100-112mmHg),platelet count decreased progressively(65×10^(9)·L^(-1)),with lactate dehydrogenase of 367 U·L^(-1),alanine aminotransferase of 121.8 U·L^(-1),and aspartate aminotransferase of 89 U·L^(-1),and the disease progressed to HELLP syndrome.The clinical pharmacists participated in the treatment of this patient,combined the patient's risk of thrombosis and bleeding,changes in platelet count,and pharmacokinetic characteristics of anticoagulant drugs to assist clinicians in formulating the individualized anticoagulant treatment plan in the perinatal period,and promptly stopped and started anticoagulant drugs,which effectively prevented the patient from the occurrence of thrombosis and postpartum hemorrhage complications.Meanwhile,based on evidence-based pharmacology,the clinical pharmacists analyzed the key points of pharmacological care for such patients during pregnancy and lactation.The standardized use of OAPS treatment drugs,such as hydroxychloroquine,aspirin and prednesone,have more advantages than disadvantages during pregnancy,but the corresponding adverse reactions need to be closely monitored.Enoxaparin does not accumulate in milk and can be used safely during lactation.The clinical pharmacists play an important role in guaranteeing the safety and effectiveness of medication for pregnant and lactation patients.