目的 探讨临床药师在房颤患者个体化抗凝治疗与用药监护中的工作要点。方法 参与心内科1例老年非瓣膜病房颤合并糖尿病患者预防栓塞并发症的华法林抗凝治疗用药方案的制订与用药监护。结果 确定符合患者特点的抗凝强度, 华法林和肝素的配合方法, 通过临床药师的用药教育提高患者自我监测和对影响因素的关注。结论 个体化用药方案的设计与分析及用药监护是临床药师开展药学服务工作的切入点。
Abstract
OBJECTIVE To explore the key points of work for clinical pharmacists in individualized anticoagulant therapy in patients with atrial fibrillation. METHODS The pharmacists participated in the development of the regimen of warfarin anticoagulation and its supervision for prevention of embolism complications in one case of aged patient with non valvular disease combined with diabetes. RESULTS The anticoagulant intensity and the combination regiment of warfarin with heparin were determined according to the characteristics of the patient. Patient self-monitoring and awareness of influencing factors were improved through the medical education by clinical pharmacists. CONCLUSION Design of individualized medication regimen and medication supervision should be the breakthrough point of clinical pharmacists.
关键词
房颤 /
糖尿病 /
抗凝 /
华法林 /
病例分析
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Key words
atrial fibrillation /
diabetes mellitus /
anticoagulation /
warfarin /
case analysis
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中图分类号：
R95
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参考文献
HU D Y, GUO Y F. BAFTA Study in warfarin is better than that of aspirin to prevent stroke in atrial fibrillation (af) in the elderly events. Chin J Med Guide(中国医药导刊), 2007, 9(5):423. HYLEK E M, GO A S, CHANG Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Eng J Med, 2003, 349(11):1019-1026. GE W H. Warfarin Anticoagulant Therapy Clinical Pharmacists Instruction Manual(华法林抗凝指导手册). Beijing: People′s Medical Publishing House, 2009:5-15. GUYATT G H, AKT E A, CROWTHER M. Schuünemann and for the american college of chest physicians antithrombotic therapy and prevention of thrombosis panel. Chest, 2012, 141(2 suppl):7-47. YANG J G. The diagnosis and drug treatment of atrial fibrillation(Chinese specialist consensus). Prev Treat Cardio Cereb Vasc Dis(心脑血管病防治), 2008, 8(4):215-222. ZHENG C, MEI D. Relevant factors affecting warfarin anticoagulant effect. Adv Drug React J (药物不良反应杂志), 2007, 9(4):256-261.
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