临床药师参与43例抗凝治疗会诊的汇总及难点分析  

Summary of clinical pharmacists involvement in 43 cases of anti-thrombotic consultation and analysis of difficult points

作　　者：李平[1] 卜书红[1] 姚慧娟[1] 刘昕竹 周佳[1] 杨宇[1] LI Ping;BU Shuhong;YAO Huijuan;LIU Xinzhu;ZHOU Jia;YANG Yu(Department of Pharmacy,Xinhua Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院药学部,上海200092

出　　处：《药学服务与研究》2020年第3期169-173,182,共6页Pharmaceutical Care and Research

摘　　要：目的:分析临床药师在抗凝治疗会诊中促进合理用药的作用。方法:通过对43例抗凝会诊案例做分类统计,归纳出医师关注度集中的抗凝药物品种,再对其临床应用的难点进行分析讨论。选取4例有代表性的疑难会诊病例,重点分析在面对弥散性血管内凝血、肝素诱导的血小板减少、肾功能不全、连续肾脏替代疗法以及维生素K摄入不足等挑战时,肝素类药物与华法林的使用策略。结果和结论:临床抗凝治疗会诊涉及的药物主要为肝素类药物以及华法林,其难点在于危重患者的合理用药。临床药师参与会诊,对安全、有效的抗凝治疗具有重要作用。Objective:To analyze the role of clinical pharmacists in promoting rational drug use in anti-thrombotic consultations.Methods:Based on the classification and statistics of 43 cases of anti-thrombotic consultation,the types of anticoagulant drugs attracting concern of physicians were summarized,and then analysis and discussion were held concerning the difficulties in clinical application.Four typical complicated cases for consultation were selected,with the chief points focusing on the strategies for the application of warfarin and heparins in face of disseminated intravascular coagulation,heparin-induced thrombocytopenia,renal insufficiency,continuous renal replacement therapy and insufficient vitamin K intake.Results and Conclusion:The drugs involved in clinical anticoagulation consultation were mainly heparins and warfarin,and the chief difficult point lies in the rational use of drugs in critically ill patients.Active involvement of clinical pharmacists in consultations could play an important role in safe and effective anti-thrombotic therapy.

关 键 词：抗凝治疗 临床药师 会诊 合理用药 华法林 低分子量肝素 

分 类 号：R973.2[医药卫生—药品] R969.3[医药卫生—药学]