Pharmaceutical care in thrombocytopenia after bioprosthetic heart valve replacement
- VernacularTitle:心脏生物瓣膜置换术后并发血小板减少症的药学监护实践
- Author:
Huanli YIN
1
;
Yuezhou HUANG
1
;
Min LUO
2
Author Information
1. Dept. of Clinical Pharmacy，West China Hospital，Sichuan University，Chengdu 610041，China;Dept. of Pharmacy，West China Tianfu Hospital，Sichuan University，Chengdu 610213，China
2. Dept. of Clinical Pharmacy，West China Hospital，Sichuan University，Chengdu 610041，China
- Publication Type:Journal Article
- Keywords:
bioprosthetic heart valve replacement;
thrombocytopenia;
anticoagulation therapy;
drug-induced liver injury
- From:
China Pharmacy
2026;37(1):77-82
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide a reference for anticoagulation therapy， adverse drug reaction monitoring， and individualized medication adjustment in complex cases， such as those with thrombocytopenia following bioprosthetic heart valve replacement. METHODS Clinical pharmacists participated in the pharmaceutical care of a patient with thrombocytopenia following bioprosthetic heart valve replacement. For cardiac insufficiency， the pharmacists recommended maintaining oral bisoprolol， sacubitril/valsartan， spironolactone， furosemide， and potassium chloride， with levosimendan added to enhance myocardial contractility， while monitoring blood pressure， heart rate and serum potassium levels. For thrombocytopenia， based on literature- based risk assessment， the pharmacists advised administering recombinant human interleukin-11 （rhIL-11）， platelet transfusion， and employing anticoagulation therapy with nadroparin calcium bridging to warfarin， with warfarin dosage adjusted according to the international normalized ratio （INR）. For rapid ventricular rate atrial fibrillation， amiodarone and digoxin were recommended. For acute liver injury， suspected to be induced by amiodarone and rhIL-11， the pharmacists suggested discontinuing the relevant drugs and treating with ademetionine 1，4-butanedisulfonate combined with polyene phosphatidylcholine for liver protection treatment. The patient received anticoagulation medication education emphasizing strict INR monitoring and close observation for bleeding or thrombotic events. RESULTS The clinicians adopted these recommendations. Following the intervention， the patient’s liver function showed significant improvement， with alanine aminotransferase decreasing to 70 U/L and aspartate aminotransferase to 42 U/L. The ventricular rate stabilized at 70-100 beats per minute， cardiac function remained stable， the INR was maintained within the target range of 1.80-2.50， and the patient was ultimately discharged with improved condition. CONCLUSIONS Through balancing anticoagulation and bleeding risks， the clinical pharmacists applied pharmaceutical expertise to assist in developing personalized anticoagulation regimens， conducted adverse drug reaction monitoring and evaluation， and optimized medication strategies， thereby effectively ensuring patient safety and therapeutic efficacy.
