临床药师参与1例华法林个体化抗凝治疗的药学实践  

Individualized Anticoagulant Therapy for Warfarin in a Patient with Poor Metabolism

作　　者：李宇 樊晖晖[1] 冯晓俊 王运红[1] 陈传涛[1] 张蕾[2] LI Yu;FAN Huihui;FENG Xiaojun;WANG Yunhong;CHEN Chuantao;ZHANG Lei(Department of Pharmacy,People's Hospital of Taihe County,Taihe Anhui 236600,China;Department of Pharmacy,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei Anhui 230001,China)

机构地区：[1]太和县人民医院药剂科,安徽太和236600 [2]中国科学技术大学附属第一医院,安徽省立医院药剂科,安徽合肥230001

出　　处：《中国药物警戒》2020年第12期939-942,共4页Chinese Journal of Pharmacovigilance

基　　金：太和县科技项目(2018WS5009)。

摘　　要：目的探讨临床药师在华法林个体化抗凝治疗中的作用。方法临床药师参与1例患者的华法林个体化抗凝治疗过程,根据指南建议停用阿司匹林,单用华法林治疗。根据基因检测结果调整华法林剂量,并随访行凝血酶原时间、国际标准化比值及有无出血事件发生等药学监护。结果医生接受临床药师建议,停阿司匹林,应用华法林1.25 mg/d,检查结果均在目标范围内,无出血和栓塞事件发生。结论临床药师通过基因检测指导华法林个体化给药,保障患者用药安全和有效,实现抗凝治疗的全程化、个体化、最优化。Objective To investigate the role of clinical pharmacists in individualized anticoagulation therapy of warfarin.Methods The clinical pharmacist participated in the individualized anticoagulant treatment of warfarin in one patient.According to the guidelines,the clinical pharmacist recommend discontinuing aspirin and using warfarin monotherapy.The dose of warfarin was adjusted according to the genetic test results,the prothrombin time,INR and the occurrence of bleeding events and other pharmaceutical monitoring datas were followed.Results The doctor accepted the advice of clinical pharmacists,discontinued aspirin and warfarin 1.25mg/d was applied.The detection results were within the target range,no bleeding and embolic events occurred.Conclusion Clinical pharmacists guide individualized administration of warfarin through genetic testing to ensure the safety and effectiveness of medication for patients and realize the whole-process,individualization and optimization of anticoagulation therapy.

关 键 词：细胞色素P4502C9和维生素K环氧化物还原酶复合体1基因 华法林 个体化 抗凝 药学实践 

分 类 号：R973[医药卫生—药品]