达比加群酯联合用药致牙龈出血的个体化给药及药学监护  

Individualized administration and pharmaceutical care of one case of gingival bleeding caused by dabigatran etexilate in combination

作　　者：王林艳 谭喜莹[2] 姚东[1] 邵志焰 WANG Linyan;TAN Xi-ying;YAO Dong(Jingjiang Hospital of Traditional Chinese Medicine,Jingjiang 214500,China;不详)

机构地区：[1]靖江市中医院,江苏靖江214500 [2]江苏省中医院,南京210029

出　　处：《中国处方药》2022年第10期47-50,共4页Journal of China Prescription Drug

摘　　要：目的通过对房颤合并心衰患者个体化给药的分析,为临床药师促进临床安全用药提供参考。方法临床药师基于1例药物治疗房颤合并心衰患者引发牙龈出血的病例,结合患者基础疾病、联合用药情况,进行不良反应发生原因分析、药物方案评价,进而为用药方案调整提出意见和建议。结果基于患者基础疾病及用药,考虑达比加群酯是导致出血的主要药物,患者高龄、肌酐清除率低于30 ml/min,可能是导致达比加群酯引发患者牙龈严重持续性出血的主要原因;联合用药分析结果提示出血还可能与阿托伐他汀、麝香保心丸与芪参益气滴丸与达比加群酯的联用,导致抗凝、抗血小板作用增强有关。基于患者房颤合并肾功能不全情况及药物可获得性,建议达比加群酯减量使用,经讨论后医生采纳建议,并通过进一步药学监护,保障了患者用药安全。结论在临床中充分发挥临床药师的作用,建立药师与医生的良好合作关系,将有助于促进临床安全合理用药。Objective To provide a reference for clinical pharmacists to promote clinical safe medication through the analysis of individualized drug administration in patients with atrial fibrillation and heart failure.Methods Based on a case of gingival bleeding occurred in the treatment of atrial fibrillation with heart failure,opinions and suggestions were put forward for the adjustment of drug regimen,as the causes of adverse reactions and the drug regimen were analyzed and evaluated by the clinical pharmacists according to the characteristics of basic diseases and combined medication.Results Dabigatran etexilate were considered as the main drug which leaded to bleeding based on the patients'basic diseases and medication.Elderly and creatinine clearance rate lower than 30 ml/min may be the main causes of severe persistent gingival bleeding leaded by dabigatran etexilate.The results of combined medication analysis suggest that the bleeding may also be related to the combination of atorvastatin,Shexiang Baoxin Pills,Qishen Yiqi Dropping Pills and dabigatran,resulting in enhanced anticoagulation and antiplatelet effects.Clinical pharmacists suggested that dabigatran etexilate dosage should be reduced according to the situation of atrial fibrillation complicated with renal insufficiency and the analysis of drug availability.The suggestions were adopted by the doctors after the discussion of the adjustment suggestions of individualized medication plan advanced by the clinical pharmacists.Through further pharmaceutical care,the patients'medication safety was guaranteed.Conclusion To establish a good cooperative relationship between pharmacists and doctors while play the role of clinical pharmacists in clinical practice adequately will help to promote the safe and rational use of drugs in clinical practice.

关 键 词：达比加群酯 中成药 不良反应 个体化给药 药学监护 

分 类 号：R969.3[医药卫生—药理学]