临床药师参与1例颅内静脉窦血栓形成的肥胖患者的抗凝治疗分析  

Analysis of anticoagulant therapy with participation of clinical pharmacists in an obese patient with cerebral venous sinus thrombosis

作　　者：计建军 沈哲伦 陈倩倩 王长江 Ji Jianjun;Shen Zhelun;Chen Qianqian;Wang Changjiang(Second Hospital Affiliated to Jiaxing University,Jiaxing 314000,China)

机构地区：[1]嘉兴大学附属第二医院药学部,浙江嘉兴314000

出　　处：《实用药物与临床》2025年第2期141-145,共5页Practical Pharmacy and Clinical Remedies

基　　金：嘉兴市科技计划项目(2022AD30003)。

摘　　要：目的探讨临床药师在颅内静脉窦血栓形成的肥胖患者的抗凝治疗中的作用。方法临床药师全程参与1例颅内静脉窦血栓形成的肥胖患者的抗凝治疗过程,运用抗凝药物知识,通过查阅国内外指南、文献,并结合患者具体情况和基因检测结果等信息,协助临床医生积极查找病因,制定个体化的抗凝治疗方案,监测抗凝疗效和不良反应,并对患者进行用药宣教。结果患者抗凝治疗期间未发生出血症状,且颅内静脉窦血栓症状改善后出院,出院后随访期间临床药师持续提供抗凝药学咨询服务,患者国际标准化比值(INR)持续达标。结论临床药师协助临床医师制定个体化的抗凝治疗方案,保障了颅内静脉窦血栓形成的肥胖患者抗凝治疗的安全性和有效性,体现了临床药师的自身价值。Objective To explore the role of clinical pharmacists in anticoagulant therapy for obese patients with cerebral venous sinus thrombosis.Methods A clinical pharmacist was fully engaged in the anticoagulation treatment process of an obese patient diagnosed with cerebral venous sinus thrombosis.Leveraging knowledge of anticoagulants,the pharmacist assisted clinical doctors by actively identifying the underlying cause,crafting personalized anticoagulation treatment plans,monitoring anticoagulation efficacy and adverse reactions,and educating the patient on medication adherence.This was achieved through a thorough review of domestic and foreign guidelines and relevant literature,and by considering the patient's specific conditions as well as genetic testing results.Results The patient experienced no bleeding symptoms during anticoagulant therapy and showed improvement in cerebral venous sinus thrombosis symptoms prior to discharge.During the follow-up period after discharge,the clinical pharmacist continued to provide anticoagulant pharmaceutical consulting services,and the patient's International Normalized Ratio remained within the acceptable range.Conclusion Clinical pharmacists assist clinical doctors in developing individualized anticoagulation treatment plans for obese patients with cerebral venous sinus thrombosis,which ensures the safety and effectiveness of anticoagulant therapy,thereby demonstrating their inherent value.

关 键 词：临床药师 颅内静脉窦血栓形成 基因多态性 抗凝治疗 

分 类 号：R47[医药卫生—护理学]