低体质量多重用药患者利伐沙班个体化抗凝治疗一例  

Precision therapy of rivaroxaban in a patient with low-body-weight and polypharmacy patient:a case report

作　　者：刘莹[1,2] 唐筱婉[1] 陈跃鑫 都丽萍[1] LIU Ying;TANG Xiao-wan;CHEN Yue-xin;DU Li-ping(Department of Pharmacy,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Pharmacy,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院药剂科,北京100730 [2]首都医科大学附属北京朝阳医院药事部,北京100020 [3]中国医学科学院北京协和医学院北京协和医院血管外科,北京100730

出　　处：《临床药物治疗杂志》2024年第5期83-86,共4页Clinical Medication Journal

基　　金：中央高水平医院临床科研专项(2022-PUMCH-A-199);中国医学科学院中央级公益性科研院所基本科研业务费项目(2022-RW350-01)。

摘　　要：抗凝治疗需要不断权衡血栓与出血风险,面对抗凝治疗的特殊人群则应更明确患者的个体特征和抗凝治疗的影响因素,制订个体化的治疗策略。本文介绍1例临床药师参与的低体质量多重用药患者利伐沙班个体化抗凝治疗实践,涵盖其抗凝药物选择、给药剂量调整及药学监护的方法和过程。此类患者抗凝出血和再发血栓风险均较高,临床药师根据患者具体情况设计了基于循证的个体化给药方案,并通过利伐沙班血药浓度监测保障了抗凝治疗的有效性和安全性,有助于实现患者的最佳抗凝治疗结局。Anticoagulation therapy needs to constantly weigh the risk of thrombosis and bleedings.For special popula⁃tions undergoing anticoagulation therapy,individual characteristics of patients and influencing factors of anticoagulant therapy should be more clearly defined,and individualized treatment strategies should be developed.This article offered a case of riva⁃roxaban anticoagulation therapy practice in a patient with low body weight and polypharmacy,with the participation of clini⁃cal pharmacists.It covers the selection of anticoagulant drugs,dosage adjustment,and methods and processes of pharmaceuti⁃cal care.Such patients always have a high risk of both anticoagulation bleeding and recurrent thrombosis.Clinical pharmacists designed an evidence-based individualized dosing regimen according to the specific conditions of the patient and ensured the effectiveness and safety of anticoagulation therapy through the monitoring of rivaroxaban blood concentration,which helped to achieve the best outcome of anticoagulant therapy for the patient.

关 键 词：低体质量 多重用药 利伐沙班 治疗药物监测 

分 类 号：R973.2[医药卫生—药品]