1例脑梗死出血转化合并心房颤动患者的药学监护  

Pharmaceutical care in a patient with hemorrhagic transformation after cerebral infarction complicated with atrial fibrillation

作　　者：高领 袁静 覃文杰 朱斌[2] 李现周 钱皎 GAO Ling;YUAN Jing;QIN Wenjie;ZHU Bin;LI Xianzhou;QIAN Jiao(Dept.of Pharmacy,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Dept.of Pharmacy,the 71st Group Army Hospital of PLA,Jiangsu Xuzhou 221004,China;Dept.of Pediatrics,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Dept.of Pharmacy,Hunan Provincial People’s Hospital,Changsha 410005,China;Dept.of Pharmacy,the 990 Hospital of Joint Logistics Support Force,Henan Zhumadian 463000,China)

机构地区：[1]海军军医大学第一附属医院药学部,上海200433 [2]中国人民解放军陆军第七十一集团军医院药剂科,江苏徐州221004 [3]海军军医大学第一附属医院儿科,上海200433 [4]湖南省人民医院药学部,长沙410005 [5]联勤保障部队第九九零医院药剂科,河南驻马店463000

出　　处：《中国药房》2024年第24期3071-3075,共5页China Pharmacy

基　　金：国家自然科学基金面上项目(No.82171867);海军军医大学校级课题(No.2023MS025)。

摘　　要：目的为脑梗死出血转化合并心房颤动患者的药学监护提供参考。方法临床药师参与1例脑梗死出血转化合并心房颤动患者的治疗过程。针对患者支架植入及动脉取栓术后发生脑梗死出血转化,临床药师建议停用抗血小板药物,并给予血浆和冷沉淀治疗;针对患者D-二聚体显著升高,临床药师建议给予低分子肝素抗凝;针对患者脑梗死出血转化复发,临床药师建议停用利伐沙班,给予人凝血酶原复合物。结果医生采纳临床药师的建议。经治疗后,患者病情好转,准予带药出院。结论临床药师通过权衡抗凝-出血的治疗矛盾,开展凝血指标监测、判断重启抗凝的时间和指征、药学监护等药学服务,评估个体化风险,优化患者用药方案,保障了患者用药的安全性和有效性。OBJECTIVE To provide a reference for pharmaceutical care in patients with hemorrhagic transformation after cerebral infarction complicated with atrial fibrillation.METHODS Clinical pharmacists participated in the treatment practice of a patient with hemorrhagic transformation after cerebral infarction complicated with atrial fibrillation.Because the patient had a hemorrhagic transformation after cerebral infarction after stent implantation and arterial thrombolysis,the clinical pharmacists recommended stopping antiplatelet drugs and giving plasma and cold precipitation;because D-dimer was significantly elevated,the clinical pharmacists recommended anticoagulant therapy with low-molecular heparin.Due to the patient’s recurrence of hemorrhagic transformation after cerebral infarction,the clinical pharmacists recommended discontinuing rivaroxaban and administering human prothrombin complex concentrate.RESULTS The physician adopted the clinical pharmacists’recommendation.After treatment,the patient’s condition tended to improve steadily and was allowed to be discharged with medication.CONCLUSIONS The clinical pharmacists assessed the individualized risk and optimized the patient’s medication regimen by suggesting discontinuation of antiplatelet and anticoagulant drugs,carrying out pharmaceutical care such as coagulation index monitoring,determining the time and indications for restarting anticoagulation,and pharmaceutical monitoring,to ensure the safety and efficacy of the patient’s medication.

关 键 词：脑梗死出血转化 心房颤动 抗凝重启 药学监护 临床药师 

分 类 号：R969.3[医药卫生—药理学]