1例人工瓣膜置换患者抗凝治疗的药学实践

Practice of Anticoagulant Therapy for a Patient Receiving Heart Valve Replacement Surgery Participated by Clinical Pharmacists

目的通过1例机械瓣膜置换术后患者的抗凝治疗经过,分析机械瓣膜置换术后抗凝药物、抗凝强度及抗凝过量后的处理,同时纠正不合理用药,促进合理用药。方法临床药师介入1例风湿性二尖瓣关闭不全并发心力衰竭患者行“瓣膜置换术”后的抗凝治疗,协助制定抗凝方案,分析引起抗凝过量的原因并提供处理意见,同时全程监控治疗药物,就不合理用药提出警示。结果患者转归良好,住院及出院随访期间未发生不良事件。结论临床药师的参与有助于精细化管理患者的药物治疗方案,并及时纠正不合理用药,更好的为患者服务。

OBJECTIVE To analyze the anticoagulant drugs,anticoagulant intensity and the management of excessive anticoagulation,and to correct irrational drug use and promote rational drug use by pharmaceutical practice of clinical pharmacists in a patient undergoing mechanical valve replacement.METHODS Clinical pharmacists were involved in the anticoagulant treatment of a patient after heart valve replacement who was diagnosed as rheumatic mitral insufficiency with heart failure.Pharmacists assisted in the formulation of anticoagulant program,analyzed the causes of anticoagulant excess and provided treatment suggestions,and monitored the therapeutic drugs throughout the process to warn against unreasonable use of drugs.RESULTS The patient had a good outcome and no adverse events occurred during hospitalization and discharge follow-up.CONCLUSION The participation of clinical pharmacists is helpful for fine management of drug therapy,timely correction of irrational drug use,and better service for patients.