摘要
1例67岁女性患者,因急性肺栓塞,外院予抗凝治疗3 d后转入我院继续治疗。入院后予以依诺肝素5100 IU抗凝治疗,第3天加用华法林2.5 mg联合抗凝,至第11天国际标准化比值(INR)为1.26,故增加华法林剂量至3.75 mg,第15天监测INR仍为1.31。临床药师结合患者病史、饮食、药物相互作用等因素,考虑并用药物参芪扶正可能会减弱华法林的作用,同时不能排除患者存在华法林抵抗可能。与医师交流,建议停用参芪扶正,增加华法林剂量,同时对华法林基因型进行检测,取得医师的认同。第17天,监测患者INR 1.97,第19天INR上升至2.47。因患者急于出院,于第20天将华法林剂量调整为3.75 mg带药出院,门诊随访治疗。1个月后电话回访了解到患者服用华法林期间INR维持在2.0~3.0之间,未出现出血等不良反应。
A67-year-old female patient was transferred to our hospital for the treatment of acute pulmonary embolismafter3days of anticoagulant treatment in other hospital.The patient was given enoxaparin(5100IU)for anticoagulant therapy afteradmission,and then2.5mg warfarin combined with enoxaparin for anticoagulation were used on the third day.The internationalstandardization ratio(INR)of the patient was only1.26on the11th day.Although with an increase of warfarin doses to3.75mg,theINR was still only1.31on the15th day.With a comprehensive consideration of the medical history,dietary custom,drug interactionand other factors of the patient,the clinical pharmacist considered that the Chinese patent medicine of Shenqi Fuzheng might makethe warfarin less effective,but not excluding a warfarin resistance in this patient.After communication with the physician,the clinicalpharmacist suggested to stop using Shenqi Fuzheng,increase the dose of warfarin,and test the genotype associated with warfarin,andthose suggestions obtained the approval of the doctor.By following the advice,the patient's INR increased to1.97on the17th day,and kept increasing to2.47on the19th day.Because the patient was discharged from hospital on the20th day,the dose of warfarin wasadjusted to3.75mg.After a month,the clinical pharmacist was informed that the patient's INR was maintained between2.0and3.0during the time of taking warfarin,without adverse effects such as hemorrhage by telephone follow-up.
作者
陈元娜
陈梦嘉
马卫成
杜瑱男
CHEN Yuan-na;CHEN Meng-jia;MA Wei-cheng;DU Zhen-nan(Department of Pharmacy, Ningbo Yinzhou No.2 Hospital,Zhejiang Province, Ningbo 315100, China;Department of Respiration, Ningbo Yinzhou No.2 Hospital, Zhejiang Province, Ningbo 315100,China)
出处
《中国药物应用与监测》
CAS
2017年第4期218-220,共3页
Chinese Journal of Drug Application and Monitoring
关键词
华法林
国际标准化比值
参芪扶正
药学监护
Warfarin
International normalized ratio
Shenqi Fuzheng
Pharmaceutical care
