临床药师参与1例下肢深静脉血栓患者抗凝方案调整分析

摘 要 目的：探讨临床药师在抗凝药物治疗中的作用。方法: 临床药师参与1例下肢深静脉血栓患者抗凝方案的调整。药师评估了深静脉血栓的危险因素和抗凝的出血风险，出现华法林抗凝过度时提出合理的治疗建议，治疗过程中发现患者的不依从性并提供充分的用药教育。结果: 医生采纳治疗建议，INR控制在合理范围内，患者病情平稳出院。结论:临床药师参与华法林的抗凝治疗，可有效减少用药风险，提高治疗的安全性和有效性。

Analysis of Anticoagulant Treatment Adjustment Participated by Clinical Pharmacist for a Patient with Deep Vein Thrombosis of Lower Limbs

ABSTRACT Objective: To investigate the role of clinical pharmacist in anticoagulant therapy. Methods: Clinical pharmacist participated in the anticoagulant treatment adjustment for one patient with deep vein thrombosis (DVT) of lower limbs. Clinical pharmacist assessed the risk factors of DVT and the bleeding risk of anticoagulant therapy, provided suggestions in case of over anticoagulation with warfarin, and offered medication education to the patient with unsatisfactory compliance. Results: Physician adopted the suggestions of clinical pharmacist, INR was within the rational range, and the patient was discharged with stable condition. Conclusion:The participation of clinical pharmacist in the anticoagulation with warfarin can reduce the risks of drug use and promote the efficacy and safety of medication effectively.