临床药师参与1例低分子肝素诱导的血小板降低合并肺栓塞患者的药学监护  

Clinical pharmacists participated in the pharmaceutical care of a patient with low molecular weight heparin-induced thrombocytopenia complicated by pulmonary embolism

作　　者：姚莉[1] 赵生俊[1] 王丽霞[2] YAO Li;ZHAO Shengjun;WANG Lixia(Department of Clinical Pharmacy,Traditional Chinese Medical Hospital affiliated to Xinjiang University,Urumqi 830000,China;Department of Respiration,Traditional Chinese Medical Hospital affiliated to Xinjiang University,Urumqi 830000,China)

机构地区：[1]新疆医科大学附属中医医院药学部,乌鲁木齐830000 [2]新疆医科大学附属中医医院呼吸与危重症医学科,乌鲁木齐830000

出　　处：《上海医药》2022年第21期68-71,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：新疆维吾尔自治区药学会科研基金资助项目(YHX201804)。

摘　　要：目的 :通过对1例低分子肝素诱导血小板减少症患者的药学监护,探讨该类患者的临床治疗思维及用药监护点。方法 :临床药师参与1例肝素诱导血小板减少症患者的诊治,协助医师优化药物治疗方案,避免药品不良反应的发生。结果 :考虑患者出现低分子肝素诱导的血小板减少症,停用低分子肝素,调整为比伐芦丁泵入2 d至患者的急性症状改善,过渡到近6周的磺达肝癸钠替代抗凝治疗,患者血小板逐渐回升至基础值,最后抗凝桥接治疗调整为华法林口服。结论 :临床药师参与治疗方案的优化和调整,为患者的用药安全提供保障。Objective: To discuss the clinical treatment thinking and medication monitoring points of such patients through the pharmaceutical care of a patient with low molecular weight heparin-induced thrombocytopenia. Methods: Clinical pharmacist participated in the treatment practice of a patient with low molecular weight heparin-induced thrombocytopenia,assisted the physician in optimizing the drug treatment regimen and avoiding adverse drug reaction. Results: Low molecular weight heparin was stopped considering heparin-induced thrombocytopenia and the treatment regimen was switched to minipumping bivalirudin for 48 hours until the clinical acute symptoms disappeared, and then transitioned to nearly 6 weeks of fondaparinux sodium replacement anticoagulation and the platelets were substantially recovered to normal. Finally, bridging anticoagulation therapy was adjusted to oral warfarin. Conclusion: Clinical pharmacists can guarantee the safety of medication by participating in the optimization and adjustment of treatment regimen.

关 键 词：血小板减少症 肝素诱导肺栓塞 磺达肝癸钠 

分 类 号：R973.2[医药卫生—药品] R969.3[医药卫生—药学]