一例联合应用华法林和氯吡格雷导致消化道出血患者的药学监护

目的探讨1例联合抗栓治疗导致消化道出血患者的抗栓治疗方案优化及临床药师的作用。方法临床药师结合患者疾病史、临床特征、实验室检查等多方面因素,通过文献查阅,比较不同抗血小板药物特点,针对患者不同临床疾病进展,合理选用抗栓治疗药物并进行药学监护。结果患者的消化道出血与华法林+氯吡格雷联合抗栓治疗有关,临床药师建议华法林+氯吡格雷调整为华法林+吲哚布芬,监护3个月,患者无出血发生。结论在抗栓治疗过程中,临床药师评估患者出血及栓塞的风险,从药物机制、药物相互作用、患者临床特点等方面进行综合分析,制定最适合的抗栓治疗方案,保证了患者的安全用药。

Pharmacological monitoring of a patient with gastrointestinal bleeding caued by combined use of warfarin and clopidogrel

Objective To explore the optimization of antithrombotic therapy and the role of clinical pharmacists in a patient with gastrointestinal bleeding induced by combined antithrombotic therapy.Methods Based on the patient′s disease history,clinical characteristics,laboratory examination and other factors,the clinical phamacists compared the characteristics of different antiplatelet drugs through literature review,and according to the progress of different clinical diseases reasonable selection of antithrombotic drugs and pharmaceutical monitoring were made.Results The gastrointestinal bleeding of the patient was related to the combined use of warfarin with clopidogrel as antithrombotic therapy.Clinical pharmacists suggested that warfarin with clopidogrel be adjusted to warfarin with indobufen,no bleading occurred during the 3-month monitoring period.Conclusion In the course of antithrombotic treatment,the clinical pharmacists assess the risk of bleeding and embolism,make a comprehensive analysis from the aspects of drug mechanism,drug interaction and clinical characteristics of patients,and formulate the most suitable antithrombotic treatment plan to ensure the safe use of drugs for patients.