1例儿童肺栓塞的抗凝治疗分析和药学监护

目的:为临床药师参与儿童肺栓塞的抗凝治疗及药学监护提供参考。方法:临床药师参与1例肺栓塞患儿的抗凝治疗过程,提供个体化药学服务。结果:临床药师在抗凝药物选择、剂量调整、合并用药及饮食宣教方面提供了个体化建议和药学监护,保障了患儿抗凝治疗的安全、有效。结论:临床药师在儿科个体化抗凝治疗和安全用药中发挥了重要作用。     

临床药师参与抗凝治疗管理的实践与体会

［摘要］目的探索临床药师参与抗凝治疗管理的工作方法与模式。方法针对心脏瓣膜置换术后患者,临床药师采取每日参与医疗查房、审核医嘱、根据凝血酶原时间/国际标准化比值（PT/INR）调整华法林剂量、药学查房、指导患者用药、进行抗凝教育、对患者进行随访等形式开展抗凝治疗管理工作,评价抗凝管理方法与效率的相关性、抗凝药物剂量与安全性等问题。结果通过2 a的探索与实践,已经形成了临床药师进行抗凝治疗管理的工作模式。临床药师已逐渐成为抗凝治疗团队中不可缺少的成员。结论抗凝治疗管理可成为药师深入临床开展药学服务及临床药学研究的切入点,体现药师的价值。     

慢性肾脏病患者抗凝管理策略与个体化治疗实践

探讨慢性肾脏病患者口服抗凝药物的治疗与管理策略以及临床药师在抗凝个体化与精准治疗中的药学服务重点。临床药师基于最新的临床研究、荟萃分析及治疗指南，通过综合评估出血风险及栓塞风险，为慢性肾脏病患者制定个体化的抗凝治疗方案。慢性肾脏病患者口服抗凝药物的遴选、新型口服抗凝药物的剂量调整、围术期的抗凝管理、长期预防性抗栓策略以及华法林药物基因组学等均是临床药师开展个体化药学服务的出发点与关切点，从而协助医生制定更为安全、有效、精准的药物治疗方案。     

临床药师对长期抗凝的心房纤颤患者的药学监护*

目的：探讨临床药师对长期抗凝治疗的心房纤颤患者进行药学监护的切入点和要点。方法：从传统口服抗凝药与新型口服抗凝药之间的转换、药物相互作用、围手术期抗凝策略、抗凝药物的不良反应、出院用药教育五个角度,临床药师提供个体化药学监护和指导。结果：临床药师通过参与对房颤患者的药学监护,有助于保障患者的用药安全性、合理性和延续性。结论：临床药师应积极参与房颤患者的抗凝治疗,并提出合理化建议。     

基层医院临床药师指导华法林抗凝治疗非瓣膜病心房颤动与传统治疗的差异

目的：探讨基层医院临床药师指导华法林抗凝治疗非瓣膜病房颤与传统治疗的差异,为基层医院临床药师开展临床药学服务提供参考。方法：2010年1月-2014年12月,收治非瓣膜病心房颤动患者58例,随机数字表法分成临床药师指导华法林抗凝治疗组28例（指导组）和非临床药师指导华法林抗凝治疗组30例（传统组）。指导组由临床药师采用药学服务模式指导患者华法林抗凝治疗、INR自主监测与剂量调整;传统组由医师依据INR值调整用药剂量、交代药物用法用量和注意事项的临床常规方式进行华法林抗凝治疗;2组目标国际标准化值（INR）均为2.0~3.0（年龄≥75岁者为1.5~2.5）,治疗开始后每间隔5 d在院监测一次INR值。2组患者开始华法林抗凝治疗的第12个月做一次随访调查。结果：2组患者达目标国际标准化值（INR）的比例有显著性差异（P<0.05）;自我监测与剂量调整能力、用药依从性和安全性方面的随访调查,结果有显著性差异（P<0.05）。结论：临床药师采用药学服务模式指导华法林抗凝治疗非瓣膜病心房颤动患者的方法效果显著。     

临床药师对长期抗凝的心房纤颤患者的药学监护*

目的：探讨临床药师对长期抗凝治疗的心房纤颤患者进行药学监护的切入点和要点。方法：从传统口服抗凝药与新型口服抗凝药之间的转换、药物相互作用、围手术期抗凝策略、抗凝药物的不良反应、出院用药教育五个角度,临床药师提供个体化药学监护和指导。结果：临床药师通过参与对房颤患者的药学监护,有助于保障患者的用药安全性、合理性和延续性。结论：临床药师应积极参与房颤患者的抗凝治疗,并提出合理化建议。     

抗凝治疗全程药学管理在血栓栓塞性疾病防治中的应用

目的 探讨临床药师开展抗凝治疗全程药学管理对抗凝治疗的安全性、合理性、有效性和依从性的影响。方法 选取2019年12月～2020年12月期间临床药师开展抗凝治疗全程药学管理的病例，通过入院时、住院中、出院时、出院后门诊随访四个维度开展药学服务，并统计分析各项措施实施后的效果。结果 临床药师共开展抗凝药学监护398例，药物重整189例，其中抗凝药物剂量重整28例(14.81%)。抗凝治疗药物使用合理率由56.67%显著提高到93.33%。华法林抗凝治疗TTR达标率由干预前17.3%提高到55.77%。全程药学管理的患者对抗凝治疗的依从性(96.7%)显著高于管理前(80.61%)。结论 临床药师开展抗凝治疗全程药学管理有助于提高患者的治疗安全性、合理性、有效性、依从性，药师在工作中不断创新，也是全程药学服务工作顺利实施的必要条件。     

华法林抗凝门诊管理模式

该文通过检索近年来国内、外相关文献,对临床药师参与华法林抗凝个体化治疗研究方面的论文进行分析、归纳、总结为建立华法林抗凝门诊、推动抗凝治疗的个体化药学服务提供参考。建立抗凝门诊,临床药师协同医师为患者制定个体化用药方案,掌握华法林个体化用药规律,促进华法林抗凝的安全、合理应用。     

临床药师参与1例卒中伴房颤患者的抗凝治疗分析

目的探讨临床药师参与卒中伴房颤患者抗凝治疗的方法和药学服务。方法临床药师参与1例卒中伴房颤患者的抗凝诊疗过程,针对抗凝治疗指征及目标值、华法林桥接低分子肝素的目的、华法林的药物相互作用、INR异常升高的处理以及华法林的用药教育等方面进行综合分析。结果临床药师在抗凝治疗中,为患者建立了抗凝治疗信息档案,同时发现抗凝治疗问题,及时向医师提供合理化的治疗建议。结论临床药师参与抗凝治疗管理,促进患者安全、合理、有效地使用药物。     

临床药师参与1例肝硬化合并门静脉血栓患者的抗凝治疗

临床药师通过参与1例肝硬化合并门静脉血栓患者的抗凝治疗,探讨临床药师在临床治疗中发挥的作用。面对治疗矛盾,临床药师通过查阅相关指南、文献,在抗凝时机、抗凝药物的选择、给药方案优化及药学监护等方面为医师及患者提供临床药学服务,提高患者用药的有效性和安全性。     

Enoxaparin: a pharmacologic and clinical review

Introduction: Both arterial and venous thromboembolism constitute a significant disease burden worldwide, leading to major use of healthcare resources. As anticoagulants play a pivotal role in the treatment of these disorders, it is vital for healthcare providers to have sufficient knowledge of their biochemical and clinical attributes.

Areas covered: Enoxaparin is one of the most commonly used low-molecular-weight heparins in a wide variety of thromboembolic disorders and has several advantages over unfractionated heparin. An analysis of its biophysical profile, with special emphasis on pharmacokinetic and pharmacodynamic properties, is undertaken in this article. In addition, most recent major clinical studies elucidating its role in common thromboembolic conditions are discussed, while keeping the historical perspective at hand. Readers will be able to understand the pharmacologic properties of enoxaparin with their clinical relevance for day-to-day use and critically analyze the amount and weight of scientific evidence behind its use in various disorders.

Expert opinion: In summary, enoxaparin has been shown, by a vast amount of scientific data, to be a safe and effective agent in the treatment of a whole spectrum of acute coronary syndromes, with similar efficacy and safety in the prevention and treatment of venous thromboembolism.     

华法林与阿司匹林用于老年阵发性房颤患者抗凝治疗临床对比研究

目的对比华法林与阿司匹林用于老年阵发性房颤（NVAF）患者抗凝治疗临床效果。方法总结在我院治疗的NVAF患者46例资料,按照患者用药种类不同进行分组：选择华法林进行治疗的23例资料为治疗一组,选择阿司匹林进行治疗的23例资料为治疗二组,治疗后按照文中统计指标进行统计,最后统计学方法比较组间疗效差异性。结果治疗一组患者有1例（4.3%）发生脑栓塞,有2例患者（8.7%）有出血现象,数据结果与治疗二组无统计学差异（P〉0.05）。结论华法林与阿司匹林用于NVAF患者抗凝治疗临床疗效无统计学差异性,但阿司匹林用药更加安全、方便且具有价格优势。     

肝素抗凝血浆用于生化检验的可行性分析

目的：通过观察两种对血液处理方式的生化检验,分析肝素抗凝血浆在生化检验中是否可行,为奠定肝素抗凝血浆在检验科的地位做好准备。方法将随机并自愿受试的、生理情况正常的120例做生化检验的患者选出,所有患者均接受采血6 mL,分别注入两种颜色（标签颜色分红、蓝两组颜色,红色为真空普通试管,蓝色为真空肝素抗凝血浆试管）不同的试管,分别进行生化分析,仪器型号为西门子2400,生化分析完毕后将两组所测定值进行统计学处理。结果通过观察,两组分别得到了测定值,血清组和血浆组组间比较,存在差异的（P〈0.05）指标有K＋、Na＋、GLU 、LDH、CO2,而相比之下所剩下的其他指标则差异不大（P〉0.05）,如：Cl-、CR、BUN、AST、UA、B-AMY、CK、CK-MB、LPS。结论分析结果证实了肝素抗凝血浆在生化中的可行性,为检验科今后应该继续使用该技术做了更为确定性的表达,血液凝固过程延长、标本分离时间缩短、血液互溶情况减少等都是肝素抗凝血浆在生化中应用的特异性优点,该技术推广可以更为清晰准确的测量出指标的浓度,关于钾离子测量的微小差异也能因此而得到纠正,故在临床中反应出患者最真实的病情,这一点是十分有意义的。     

Pharmacodynamics,pharmacokinetics and clinical efficacy of apixaban in the treatment of thrombosis

Introduction: Venous thromboembolism (VTE) is a common disorder. Heparin and vitamin K antagonists have been the standard treatment for VTE for over 50 years. The development of apixaban and other direct oral anticoagulants has greatly increased the range of anticoagulants available for the treatment of VTE.

Area covered: Studies on the chemistry, pharmacodynamics and pharmacokinetics of apixaban are reviewed. Its clinical efficacy and safety are discussed, with an emphasis on randomized controlled Phase III clinical trials on treatment of thrombosis.

Expert opinion: Apixaban is a safe and effective anticoagulant for VTE treatment. It has several attractive features: its oral activity, rapid action, limited drug- interaction profile and limited need for laboratory monitoring. An antidote may become available in the near future. Further studies of certain patient populations such as patients with cancers, elderly (aged 75 years and older) and those with severe renal and liver disease, are required as these patients have not yet been studied in sufficient numbers. As clinical trials included only selected patients, data from these studies may not reflect the ‘real-life’ patients in clinical practice. There is therefore an unmet need for large post-registration studies of unselected ‘real-life’ patients, such as registry studies, to validate the clinical trial findings.     

综合抗凝治疗预防老年性下肢骨折深静脉血栓的临床研究

目的:探讨对老年人下肢骨折围手术期应用低分子肝素钠配合间歇充气加压装置预防深静脉血栓(DVT)形成的安全性和有效性。方法:回顾分析2009年1月—2011年6月收治的177例下肢各类型骨折老年患者,术前超声多普勒证实双下肢均无DVT,围手术期均应用低分子肝素钠配合间歇充气加压装置预防治疗。结果:177例患者围手术期出现有症状深静脉血栓4例,发生率为2.26%;出现致命性肺栓塞1例,发生率为0.56%。结论:老年患者下肢骨折围手术期应用低分子肝素钠配合间歇充气加压装置综合防治,可显著降低下肢深静脉血栓形成的发生率。     

T-686, a novel inhibitor of plasminogen activator inhibitor-1, inhibits thrombosis without impairment of hemostasis in rats

The aim of this study was to evaluate the antithrombotic potential of T-686 ((3E,4E)-3-benzylidene-4-(3,4,5-trimethoxy-benzylidene)-pyrrolidine-2,5-dione), a novel inhibitor of plasminogen activator inhibitor-1 (PAI-1), in rat thrombosis models. T-686 (0.1–100 mg/kg per day, p.o.) dose dependently decreased the weight of venous thrombi induced by a combination of stasis and hypercoagulability. The antithrombotic effect was enhanced by repeated administration of T-686. Warfarin (0.1 mg/kg per day for 3 days) also prevented thrombus formation. The antithrombotic action by warfarin was accompanied by prolongation of coagulation time, while no effect on coagulation time was observed in T-686-treated rats. T-686 lowered the activity of PAI-1 in plasma. In the arterio-venous shunt model, pretreatment with T-686 (10 mg/kg per day) or ticlopidine (100 mg/kg per day) for 8 days inhibited thrombus formation by 33% and 44%, respectively. T-686 had no effect on collagen-induced platelet aggregation ex vivo, while ticlopidine inhibited platelet aggregation. T-686 did not affect bleeding time at 10–100 times the antithrombotic dose, while warfarin dose dependently prolonged bleeding time at and around the antithrombotic dose. These results suggest that T-686 prevents thrombus formation in rats without impairment of hemostasis.     

Physicochemical properties and anticoagulant activity of polyphenols derived from Lachnum singerianum

In this study, polyphenols (LSP) were obtained from the fermentation broth of Lachnum singerianum. Two fractions were isolated by Sephadex LH-20 chromatographic column, and the primary fraction (LSP-1) was collected. The comprehensive physicochemical properties of phenolic acids and polyhydroxy phenolic compounds of LSP-1 were determined by UV-visible spectroscopy, Fourier transform infrared spectroscopy, and gas chromatography–mass spectrometry. Results of anticoagulant activity assay in vitro showed that LSP-1 could lengthen prothrombin time, activated partial thromboplastin time, and thrombin time of mouse plasma. In addition, anticoagulant activity results in vivo showed that high dose of LSP-1 could significantly prolong bleeding time, coagulation time, prothrombin time, activated partial thromboplastin time, and thrombin time of hypercoagulable mice induced by adrenaline, reduce the content of fibrinogen and enhance antithrombin III activity. All results indicated that the LSP-1 could serve well as an anticoagulant, and might be used as a potential natural drug candidate for thrombosis.     

某院口服抗凝药使用现状及安全性评价

目的 为临床合理使用口服抗凝药(OAC)提供参考。方法 通过医院信息系统收集2016年至2018年开具OAC患者的病历资料,了解OAC中华法林与口服非维生素K拮抗剂抗凝药(NOAC,包括利伐沙班、达比加群酯)的使用现状,对各OAC使用人次、金额、用药适应证等信息进行统计,计算再入院率及不良事件发生率,以评估OAC安全性。结果 该院服用OAC的患者逐年增加,服用NOAC的患者构成比逐年增加,但未超过华法林;与NOAC相比,华法林平均费用较低,但所致再入院率及大出血事件发生率较高。结论 综合考虑成本与效用,华法林仍是大多数服用OAC患者的首选,但不良事件风险较高,总体安全性不如NOAC。     

Warfarin toxicity and individual variability-clinical case

Warfarin is a widely used anticoagulant in the treatment and prevention of thrombosis, in the treatment for chronic atrial fibrillation, mechanical valves, pulmonary embolism, and dilated cardiomyopathy. It is tasteless and colorless, was used as a poison, and is still marketed as a pesticide against rats and mice. Several long-acting warfarin derivatives-superwarfarin anticoagulants-such as brodifacoum, diphenadione, chlorophacinone, bromadiolone, are used as pesticides and can produce profound and prolonged anticoagulation. Several factors increase the risk of warfarin toxicity. However, polymorphisms in cytochrome P450 genes and drug interactions account for most of the risk for toxicity complications. Each person is unique in their degree of susceptibility to toxic agents. The toxicity interpretation and the health risk of most toxic substances are a subject of uncertainty. Genetically determined low metabolic capacity in an individual can dramatically alter the toxin and metabolite levels from those normally expected, which is crucial for drugs with a narrow therapeutic index, like warfarin. Personalized approaches in interpretation have the potential to remove some of the scientific uncertainties in toxicity cases.