起搏器相关上肢静脉血栓1例及文献回顾

Pacemaker-associated upper extremity venous thrombosis:a case report and literature review

目的临床药师通过参与1例起搏器相关上肢深静脉血栓的抗凝治疗,为缺乏大型随机临床研究的栓塞疾病提供合理用药参考。方法1例78岁的老年男性病人起搏器植入术后24 d左上肢出现静脉血栓,临床药师通过查阅文献,结合案例报道、循证依据及病人血栓及出血风险评估,与医师共同为病人制定个体化抗凝方案,并提供药学服务。结果医师采纳临床药师抗凝治疗建议,采用利伐沙班抗凝,1个月后血栓消失,总疗程5个月,期间未有血栓和出血事件。结论临床药师可协助医师优化缺乏循证依据病种的治疗方案,提高药物治疗的安全性及有效性,为临床药学服务提供新思路。

Objective To provide reference for rational medication of thrombotic diseases in the absence of large randomized clinical studies by participating in the anticoagulation treatment of a pacemaker-associated upper extremity deep vein thrombosis.Methods A 78-year-old male patient had venous thrombosis in the left upper extremity 24 days after pacemaker implantation.The clinical pharma⁃cist worked with the physician to develop an individualized anticoagulation regimen and provided pharmacologic services for the pa⁃tient by reviewing the literature and studying case reports,evidence-based rationale,and assessing the patient's thrombotic and bleeding risks.Results The physician adopted the clinical pharmacist's anticoagulant therapy recommendations and used rivaroxaban for anti⁃coagulation,and the thrombus disappeared after 1 month.The course of treatment lasted for 5 months,during which there were no throm⁃botic or bleeding events.Conclusion Clinical pharmacists can assist physicians in optimizing treatment regimens for diseases lacking evidence-based practice,improving the safety and efficacy of drug therapy,and providing new ideas for clinical pharmacologic services.