抗凝专业临床药师的临床药学服务切入点

目的:通过具体案例分析总结我院抗凝专业临床药师的临床实践,把握其工作切入点。方法:临床药师为特殊人群、特殊病理状态、抗凝过量的患者提供抗凝治疗建议,分析药物相互作用对抗凝治疗的影响,基于患者基因型提供个体化给药方案,对患者进行用药健康教育。结果:抗凝专业临床药师参与临床药物治疗可提高抗凝治疗成功率,降低患者抗凝风险,提高患者抗凝治疗依从性。结论:抗凝专业临床药师逐步融入临床抗凝治疗团队,对患者抗凝治疗的安全性、合理性起着积极推动作用。

Clinical Practice and the Entry Points to Pharmaceutical Care of Anticoagulation Professional Clinical Pharmacists

OBJECTIVE： To sum up the clinical practice and to master the entry points to pharmaceutical care of anticoagula- tion professional clinical pharmacists through the specific cases. METHODS： Clinical pharmacists provided the anticoagulation ad- vice for the special patients as well as special pathological state and the patients with excessive anticoagulant treatment, analyzed the influence of drug interaction on anticoagulation treatment, implement the individualized medication based on pharmacogenomics and provided the health education for the patients. RESULTS： Anticoagulation professional clinical pharmacists participating in clini- cal drug treatment can improve the success rate of anticoagulation, reduce the patient＇ s risk of anticoagulation and increase the pa- tients＇compliance. CONCLUSIONS： Anticoagulation professional clinical pharmacists will gradually integrate into the team and par- ticipate in the administration management and play a positive role on the safe and rational drug use.