Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review
- VernacularTitle:血小板减少的房颤伴动脉粥样硬化患者的抗栓治疗管理策略及文献分析
- Author:
Yongjia HUANG
1
,
2
;
Ling DING
1
;
Fang ZENG
2
;
Jie LIU
1
;
Jindou LI
3
;
Yihui LIU
2
Author Information
1. Dept. of Pharmacy，Central Hospital of Chongqing Jiangjin District，Chongqing 402260，China
2. Dept. of Pharmacy，Union Hospital Affiliated to Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430022，China
3. Dept. of Gastrointestinal Surgery，Central Hospital of Chongqing Jiangjin District，Chongqing 402260，China
- Publication Type:Journal Article
- Keywords:
atrial fibrillation;
atherosclerosis;
thrombocytopenia;
antithrombotic therapy;
pharmaceutical care
- From:
China Pharmacy
2023;34(2):223-227
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide reference for the management of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis. METHODS The clinical pharmacist participated in the treatment of a thrombocytopenia patient with atrial fibrillation and atherosclerosis， and analyzed the causes of thrombocytopenia according to the patient’s medical history and laboratory examination results. At the same time， the risk of thrombosis-bleeding was evaluated according to the relevant guidelines， and the clinicians were assisted in formulating individual antithrombotic therapy plan and pharmaceutical care plan for the patient. The literature on antithrombotic therapy related to thrombocytopenia was collected and analyzed by retrieving CNKI. RESULTS Thrombocytopenia was considered as primary thrombocytopenia in this patient， and the main risk of bleeding was age ≥65 years old， bleeding tendency， and combined use of antithrombotic drugs. After the clinical pharmacist assessed the risk of thrombosis and bleeding， the clinician was recommended to give full dose of Bemiheparin sodium injection + Dronedarone hydrochloride tablets + Metoprolol succinate sustained-release tablets. In view of thrombocytopenia， the clinician gave Compound zaofan pill， Caffeic acid tablet and Sheng xuexiaoban capsule， but the patient developed diarrhea after the medication. The clinical pharmacist suggested stopping Sheng xuexiaoban capsule， and the clinician adopted the clinical pharmacist’s suggestion. When the patient was discharged from hospital， the clinical pharmacist suggested that the antithrombotic therapy plan for discharge was anticoagulation alone or selective anticoagulation. The clinician chose selective anticoagulation treatment considering that the patient’s current thrombocytopenia， urinary occult blood （+） and fecal occult blood were weakly positive， and ordered the patient to take Metoprolol succinate sustained-release tablets + Atorvastatin calcium tablets at discharge. Literature analysis showed that the causes of thrombocytopenia of patients with thromboembolism mainly included heparin induced-thrombocytopenia， immune thrombocytopenia， etc. All patients were improved after symptomatic treatment. CONCLUSIONS By participating in the management of antithrombotic therapy for the thrombocytopenia patient with atrial fibrillation and atherosclerosis， clinical pharmacists can help effectively control the patient’s condition and ensure the safety and effectiveness of drug use.
