1例剖宫产术后静脉血栓栓塞症患者的抗凝实践

Anticoagulation practice on one patient with venous thromboembolism after cesarean section

1例33岁女性患者,因剖宫产术后发生左下肢深静脉血栓和肺栓塞,给予依诺肝素(5000 IU,q 12 h,ih)抗凝治疗。用药前患者PLT 381×10^(9)·L^(-1),使用依诺肝素后PLT进行性升高,用药后第11天PLT升至744×10^(9)·L^(-1),经过对药品不良反应相关性分析,高度怀疑是依诺肝素引起的血小板增多症。建议停用依诺肝素,并根据INR不断调整华法林剂量口服抗凝治疗直至INR达标,静脉血栓栓塞好转。停用依诺肝素后,患者的PLT进行性下降,停药后第21天PLT降至355×10^(9)·L^(-1),停药后第41天随访PLT(241×10^(9)·L^(-1))降至正常。

A 33-year-old female patient had postoperative venous thromboembolism of left lower limbs and pulmonary embolism due to cesarean section and were given 5000 IU of enoxaparin for anticoagulation,twice daily.The PLT level was 381×10^(9)·L^(-1) before the medication,and was progressively elevated and increased to 744×10^(9)·L^(-1) after the treatment for 11 days.The clinical pharmacists analyzed the correlation among the adverse drug reaction and highly suspected that it was thrombocytosis induced by enoxaparin,suggesting that enoxaparin should be discontinued and should be given oral administration of anticoagulation by constantly adjusting the dosage of warfarin based on INR till INR met the standard,and the venous thromboembolism was improved.The PLT level declined progressively after the withdrawal of enoxaparin.It declined to 355×10^(9)·L^(-1) after the withdrawal for 21 days,and to the normal(241×10^(9)·L^(-1))after the withdrawal for 41 days.