1例严重肾功能不全患者抗凝方案选择的病例分析
|
摘要
本文分析1例严重肾功能不全患者的抗凝治疗方案,探讨抗凝药物治疗策略。临床药师充分评估患者牙龈出血原因,低分子肝素和新型口服抗凝药物的禁忌证后,最后选择华法林抗凝方案。此病例提醒医务人员大多数抗凝药物主要通过肾脏清除,针对严重肾功能不全的患者,尤其当患者合并多种药物,导致药物治疗风险增加时,应根据药物之间相互作用,及时调整给药剂量,做好药学监护,是降低治疗风险的关键。
The article analyzed the anticoagulant therapy regimen for a patient with severe renal insufficiency and explored the anticoagulant therapy strategies. Clinical pharmacist fully evaluated the cause of bleeding,the contraindications of low molecular weight heparin and new oral anticoagulant drugs,and finally chose warfarin as the anticoagulant drug. The case reminded medical staff that most of anticoagulant drugs are mainly cleared by kidney. For patients with severe renal insufficiency,especially when patients are treated with multiple drugs leading to an increased risk of drug treatment,the drug dosage should be adjusted according to drug-drug interactions. Doing a good job in pharmaceutical care is the key to reducing the risk of treatment.
The article analyzed the anticoagulant therapy regimen for a patient with severe renal insufficiency and explored the anticoagulant therapy strategies. Clinical pharmacist fully evaluated the cause of bleeding,the contraindications of low molecular weight heparin and new oral anticoagulant drugs,and finally chose warfarin as the anticoagulant drug. The case reminded medical staff that most of anticoagulant drugs are mainly cleared by kidney. For patients with severe renal insufficiency,especially when patients are treated with multiple drugs leading to an increased risk of drug treatment,the drug dosage should be adjusted according to drug-drug interactions. Doing a good job in pharmaceutical care is the key to reducing the risk of treatment.
引文
1 Steffal H,Verhamme P,Potpara TS,et al.The 2018 European Heart Rhythm Association Practical Guidelines on the use of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation[J].European Heart Journal,2018,39(16):1320-1393
2 中华心血管病杂志编辑委员会血栓栓塞防治循证工作组.达比加群酯用于非瓣膜病房颤患者卒中预防的临床应用建议.中华心血管杂志[J].2014,42(3):188-192
3 Nakagawa K,Hirai T,Takashima S,et al.Chronic kidney disease and CHADS(2)score independently predict cardiovascular events and mortality in patients with nonvalvular atrial fibrillation[J].J Am J Cardiol,2011,107(6):912-916
4 Hartter S,Koenen-Bergmann M,Sharma A,et al.Decrease in the oral bioavailability of dabigatran etexilate after comedication with rifampicin.Brit J Clin Pharmacol[J].2012,74(3):490-500
5 January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society:Executive summary[J].J Am Coll Cardio,2014:,64(21)1-76
6 January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].Grculation,2014,130:e199-e267
7 January CT,Wann ST,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].Circulation,2014,130(23):2071-2104
8 隋忠国,荆凡波,苏治国,等.地高辛的合理用药指导[J].中国医刊,2011,46(3):80-82
2 中华心血管病杂志编辑委员会血栓栓塞防治循证工作组.达比加群酯用于非瓣膜病房颤患者卒中预防的临床应用建议.中华心血管杂志[J].2014,42(3):188-192
3 Nakagawa K,Hirai T,Takashima S,et al.Chronic kidney disease and CHADS(2)score independently predict cardiovascular events and mortality in patients with nonvalvular atrial fibrillation[J].J Am J Cardiol,2011,107(6):912-916
4 Hartter S,Koenen-Bergmann M,Sharma A,et al.Decrease in the oral bioavailability of dabigatran etexilate after comedication with rifampicin.Brit J Clin Pharmacol[J].2012,74(3):490-500
5 January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society:Executive summary[J].J Am Coll Cardio,2014:,64(21)1-76
6 January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].Grculation,2014,130:e199-e267
7 January CT,Wann ST,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].Circulation,2014,130(23):2071-2104
8 隋忠国,荆凡波,苏治国,等.地高辛的合理用药指导[J].中国医刊,2011,46(3):80-82