1例因感染性心内膜炎行心脏瓣膜置换术后患者华法林抗凝治疗的个体化药学监护  

Individualized pharmaceutical care of warfarin anticoagulant therapy in a patient undergoing cardiac valve replacement for infective endocarditis

作　　者：毕莹 李静 BI Ying;LI Jing(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Nanchang Hongdu Hospital of TCM,Nanchang 330006,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]南昌市洪都中医院药剂科,南昌330006

出　　处：《上海医药》2022年第5期73-76,共4页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的:探讨感染性心内膜炎患者心脏瓣膜置换术后抗凝治疗的个体化药学监护思路和要点。方法:临床药师参与1例因感染性心内膜炎行心脏瓣膜置换术后患者的华法林抗凝治疗。结果:患者使用华法林抗凝期间INR异常波动,临床药师评估了患者手术后的用药、食物等多种因素对INR的影响,并结合基因检测结果给出用药方案调整建议,患者经个体化剂量调整后INR达标,无明显不良反应。结论:华法林的抗凝作用受诸多因素影响,尤其是对因感染性心内膜炎行心脏瓣膜置换术后患者,需要做好个体化的药学监护,保障患者用药有效和安全。Objective:To explore the idea and key points of individualized pharmaceutical care of a patient undergoing anticoagulation therapy after heart valve replacement due to infective endocarditis.Methods:Clinical pharmacists participated in anticoagulation treatment of a patient with infective endocarditis after heart valve replacement.Results:INR of the patient fluctuated frequently during warfarin anticoagulation treatment.Clinical pharmacists evaluated various factors such as medication,food and so on,which may affect INR after operation.The clinical pharmacists gave suggestions for drug regimen adjustment when considering the results of gene detection.After individual dose adjustment,INR rose to standard without adverse reactions.Conclusion:The anticoagulant effect of warfarin is affected by many factors,especially for patients with infective endocarditis after heart valve replacement,individualized pharmaceutical care is needed to ensure the effectiveness and safety of anticoagulant therapy.

关 键 词：华法林 药物相互作用 基因多态性 心脏瓣膜置换术 

分 类 号：R973.2[医药卫生—药品] R654.2[医药卫生—药学]