Case Analysis o f Clinical Pharmacists Participating in Warfarin Individualized Anticoagulation Therapy for a Patient with Lo- wer Extremity Venous Thrombosis Complicated with Pulmonary Arterial Thromboembolism
- VernacularTitle:临床药师参与1例下肢静脉血栓伴肺动脉血栓栓塞症患者华法林个体化抗凝治疗方案的病例分析
- Author:
Mingying DENG
1
;
Lei ZHANG
1
;
Xiaojun FENG
1
;
Tianlu SHI
1
;
Ling JIANG
1
Author Information
1. Dept. of Pharmacy，the First Affiliated Hospital，University of Science and Technology of China/Anhui Provincial Hospital，Hefei 230001，China
- Publication Type:Journal Article
- Keywords:
Warfarin;
Pharmacogenomics;
Individualized anticoagulation;
Clinical pharmacist;
Lower extremities venous thrombosis;
Pulmonary arterial thromboembolism
- From:
China Pharmacy
2019;30(6):836-839
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE： To investigate the role of clinical pharmacists in the individual anticoagulation of warfarin for the patients with lower extremity venous thrombosis （LEVT） and pulmonary arterial thromboembolism （PATE）. METHODS： Clinical pharmacists participated in individual anticoagulation of warfarin for the patients with LEVT and PATE. It was suggested to detect the gene type of the patient. According to the results of gene test [cytochrome P450 （CYP）2C9*1*1 and vitamin K epoxide reductase complex subunit Ⅰ] and the dose recommended by FDA based on the patient’s gene， the initial dose of warfarin （3.125 mg，once a day） was determined according to the patient’s living habits， height and body mass. Then the maintenance dose of warfarin （the maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day） was calculated according to the warfarin maintenance dose prediction formula established by Warfarin Pharmaeogenetics Consortium. Pharmaceutical monitoring was conducted， such as INR， prothrombin time and bleeding event monitering. RESULTS： Physicians adopted the suggestion of clinical pharmacists. The maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day. It was suggested to give Flucloxacillin sodium injection which had less influence on warfarin. The patient recovered well and was discharged. CONCLUSIONS： Based on pharmacogenomics， clinical pharmacists participate in the formulation of individualized anticoagulant regimens for patients， which promote TNR ralue of patients， reduce the risk of early postoperative thromboembolism， and further ensure the safety of drug use in patients.
