临床药师参与1例房颤伴消化道出血的5年追踪治疗分析

目的 为房颤伴高出血风险患者的药学监护提供参考.方法 跟踪随访1例房颤伴消化道出血又新发脑梗死患者5年,从房颤并消化道出血的抗凝方案、新发脑梗死的原因、左心耳封堵术后抗凝3个方面提出药学方案,并实施全程药学监护.结果 治疗期间,患者发生房颤伴消化道出血及腹泻,降低了华法林的抗凝强度,停用低分子肝素,诱发了脑梗死;病情稳...

Clinical Pharmacist Participated in a 5-Year Follow-Up Treatment of a Patient with Atrial Fibrillation Complicated with Gastrointestinal Bleeding

Objective To provide a reference for pharmaceutical care for a patient with atrial fibrillation and high-risk of bleeding.Methods A new stroked patient who got atrial fibrillation and gastrointestinal bleeding was followed-up for 5 years.The clinical data of the patient were analyzed from the anticoagulation scheme of atrial fibrillation and gastrointestinal bleeding,causes of new cerebral infarction and anticoagulation after left atrial appendage closure(LAAC)to put forward the pharmaceutical plan and implement the whole process of pharmaceutical care.Results During the treatment,the anticoagulant intensity of warfarin was reduced and low molecular weight heparin was stopped due to the occurrence of atrial fibrillation with gastrointestinal bleeding and diarrhea,which induced cerebral infarction.After the patient’s condition was stable,the clinical pharmacist recommended the use of dabigatran.After discharge,the patient had gastrointestinal bleeding again,and LAAC was performed,only aspirin was used after 180 d,and the gastrointestinal bleeding of the patient improved.Conclusion Doctors should fully assess the risk of thromboembolism and bleeding in patients with atrial fibrillation,screen and correct the reversible factors that increase the risk of bleeding while keeping anticoagulation intensity.Clinical pharmacists should strengthen medication monitoring for patients with atrial fibrillation to ensure the safe and rational use of drugs.