肾移植术后华法林不敏感患者的用药分析
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摘要
目的探讨临床药师在华法林不敏感患者个体化抗凝治疗中的作用。方法通过参与1例肾移植患者进行人工血管旁路移植术后使用华法林不敏感的抗凝治疗过程,分析该患者华法林不敏感的原因,参与药物治疗方案调整,对患者进行药学监护。结果患者同时服用的硫唑嘌呤、环孢素软胶囊和基因型(CYP2C9*1/*1和VKORC1-1639GA)是减弱华法林作用的主要因素。结论结合患者合并用药和基因型监测等因素为患者提供华法林个体化抗凝治疗,提高抗凝治疗的有效性和安全性。
Objective To explore the role of clinical pharmacists in individualized anticoagulant therapy in the patients who were insensitive to warfarin. Mehtods Through clinical pharmacists' participation in anticoagulation therapy of one prosthetic vessel bypass grafting patient after kidney transplantation,the reason for warfarin insensitivity was analyzed,the causes of warfarin insensitivity in this patient were analyzed,the adjustment of drug treatment scheme was involved,and the patients were monitored pharmacologically. Results The patient's medications such as azathioprine and ciclosporin and genotype results( CYP2 C9 * 1/* 1 and VKORC1-1639 GA) may be the reason of warfarin insensitivity.Conclusion Medications and genotype testing could provide patients with individualized warfarin anticoagulation and improve the effectiveness and safety of anticoagulant therapy.
Objective To explore the role of clinical pharmacists in individualized anticoagulant therapy in the patients who were insensitive to warfarin. Mehtods Through clinical pharmacists' participation in anticoagulation therapy of one prosthetic vessel bypass grafting patient after kidney transplantation,the reason for warfarin insensitivity was analyzed,the causes of warfarin insensitivity in this patient were analyzed,the adjustment of drug treatment scheme was involved,and the patients were monitored pharmacologically. Results The patient's medications such as azathioprine and ciclosporin and genotype results( CYP2 C9 * 1/* 1 and VKORC1-1639 GA) may be the reason of warfarin insensitivity.Conclusion Medications and genotype testing could provide patients with individualized warfarin anticoagulation and improve the effectiveness and safety of anticoagulant therapy.
引文
[1]中华医学会心血管病学分会,中国老年学学会心脑血管病专业委员会.华法林抗凝治疗的中国专家共识[J].中华内科杂志,2013,52(1):76-82.
[2]AGENO W,GALLUS A S,WITTKOWSKY A,et al.Oral anticoagulant therapy:antithrombotic therapy and prevention of thrombosis,9th ed:American college of chest physicians evidence-based clinical practice guidelines[J].Chest,2012,141(2 Suppl):S44-S88.
[3]HOLBROOK A M,PEREIRA J A,LABIRIS R,et al.Systematic overview of warfarin and its drug and food interactions[J].Arch Intern Med,2005,165(10):1095-1106.
[4]HAVRDA D,RATHBUN S,SHEID D.A case report of warfarin resistance due to azathioprine and review of the literature[J].Pharmacother,2001,21(3):355-357.
[5]ROTENBERG M,LEVY Y,SHOENFELD Y,et al.Effect of azathioprine on the anticoagulant activity of warfarin(letter)[J].Ann Pharmacother,2000,34(1):120-122.
[6]VAZQUEZ S R,RONDINA M T,PENDLETON R C.Azathioprine-induced warfarin resistance[J].Ann Pharmacother,2008,42(7):1118-1123.
[7]SINGLETON J D,CONYERS L.Warfarin and azathioprine:an important drug interaction[J].Am J Med,1992,92(2):217.
[8]SNYDER D S.Interaction between cyclosporine and warfarin(letter)[J].Ann Intern Med,1988,108(2):311.
[9]TURRI D,IANNITTO E,CARACCIOLO C,et al.Oral anticoagulants and cyclosporin A[J].Haematologica,2000,85(8):893-894.
[10]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国肾移植受者免疫抑制治疗指南(2016版)[J].器官移植,2017,7(5):1-5.
[11]都丽萍,梅丹,刘昌伟,等.CYP2C9及VKORC1基因多态性对华法林剂量和抗凝效果的影响[J].中国药学杂志,2010,45(21):1628-1633.
[12]YANG L,GE W,YU F,et al.Impact of VKORC1 gene polymorphism on inter-individual and interethnic warfarin dosage requirement-a systematic review and meta analysis[J].Thromb Res,2010,125(4):159-166.
[2]AGENO W,GALLUS A S,WITTKOWSKY A,et al.Oral anticoagulant therapy:antithrombotic therapy and prevention of thrombosis,9th ed:American college of chest physicians evidence-based clinical practice guidelines[J].Chest,2012,141(2 Suppl):S44-S88.
[3]HOLBROOK A M,PEREIRA J A,LABIRIS R,et al.Systematic overview of warfarin and its drug and food interactions[J].Arch Intern Med,2005,165(10):1095-1106.
[4]HAVRDA D,RATHBUN S,SHEID D.A case report of warfarin resistance due to azathioprine and review of the literature[J].Pharmacother,2001,21(3):355-357.
[5]ROTENBERG M,LEVY Y,SHOENFELD Y,et al.Effect of azathioprine on the anticoagulant activity of warfarin(letter)[J].Ann Pharmacother,2000,34(1):120-122.
[6]VAZQUEZ S R,RONDINA M T,PENDLETON R C.Azathioprine-induced warfarin resistance[J].Ann Pharmacother,2008,42(7):1118-1123.
[7]SINGLETON J D,CONYERS L.Warfarin and azathioprine:an important drug interaction[J].Am J Med,1992,92(2):217.
[8]SNYDER D S.Interaction between cyclosporine and warfarin(letter)[J].Ann Intern Med,1988,108(2):311.
[9]TURRI D,IANNITTO E,CARACCIOLO C,et al.Oral anticoagulants and cyclosporin A[J].Haematologica,2000,85(8):893-894.
[10]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国肾移植受者免疫抑制治疗指南(2016版)[J].器官移植,2017,7(5):1-5.
[11]都丽萍,梅丹,刘昌伟,等.CYP2C9及VKORC1基因多态性对华法林剂量和抗凝效果的影响[J].中国药学杂志,2010,45(21):1628-1633.
[12]YANG L,GE W,YU F,et al.Impact of VKORC1 gene polymorphism on inter-individual and interethnic warfarin dosage requirement-a systematic review and meta analysis[J].Thromb Res,2010,125(4):159-166.