血栓弹力图在1例经皮冠脉介入术术后急性期合并上消化道出血患者抗栓药物治疗方案调整中的应用  

Application of Thromboelastography in Anti-Thrombotic Drug Adjustment in a Patient with Acute Upper Gastrointestinal Bleeding After Percutaneous Coronary Intervention

作　　者：王晓 陈秋玲 谢守霞 刘诚 柏承文 WANG Xiao;CHEN Qiuling;XIE Shouxia;LIU Cheng;BAI Chengwen(Shenzhen People's Hospital·The Second Clinical Medical College of Jinan University·The First Affiliated Hospital of Southern University of Science and Technology,Shenzhen,Guangdong,China 518020)

机构地区：[1]广东省深圳市人民医院·暨南大学第二临床医学院·南方科技大学第一附属医院,广东深圳518020

出　　处：《中国药业》2023年第9期117-120,共4页China Pharmaceuticals

基　　金：国家自然科学基金面上项目[82073937];广东省深圳市卫生健康委员会医学重点学科[SZXK059]。

摘　　要：目的探讨血栓弹力图(TEG)对临床药师调整经皮冠脉介入术(PCI)术后急性期合并上消化道出血患者抗栓治疗方案的指导作用。方法临床药师参与1例不稳定型心绞痛患者PCI术后急性期合并上消化道出血的治疗,通过TEG监测各项指标,调整抗栓药物治疗方案,并进行全程药学监护。结果临床药师建议,双联抗血小板治疗6 d后,重启阿司匹林单抗治疗;停药10 d后,调整抗栓方案为阿司匹林肠溶片100 mg+硫氢酸氯吡格雷片75 mg,每天1次,口服。医师采纳建议,患者转归良好。结论在患者出现致命性出血事件与抗栓治疗方案发生矛盾时,可应用TEG进行个体化精准抗栓治疗方案调整,为该类患者的救治提供循证依据。Objective To investigate the guiding role of thromboelastography(TEG)for clinical pharmacists in adjusting the anti-thrombotic therapy for a patient with acute upper gastrointestinal bleeding(UGIB)after percutaneous coronary intervention(PCI).Methods A clinical pharmacist participated in the treatment of a patient with unstable angina pectoris complicated with UGIB in the acute phase after PCI.The various indicators were monitored by the TEG,the treatment plan of anti-thrombotic drugs was adjusted,and full pharmaceutical care for the patient was provided.Results The clinical pharmacist suggested that after 6 d of dual antiplatelet therapy,aspirin monoclonal antibody therapy should be restarted.After 10 d of drug withdrawal,the anti-thrombotic therapy was adjusted to oral administration of Aspirin Enteric-Coated Tablets(100 mg)+Clopidogrel Sulfate Tablets(75 mg),once a day.The physician adopted the clinical pharmacist′s suggestion,and the patient′s prognosis was good.Conclusion When there is a conflict between fatal bleeding events and anti-thrombotic therapy in the patient,TEG can be used for individualized and precise adjustment of anti-thrombotic therapy,which can provide an evidence-based basis for the treatment of these patients.

关 键 词：血栓弹力图 经皮冠脉介入术 上消化道出血 抗栓药物调整 

分 类 号：R95[医药卫生—药学] R973.2