One patient who underwent mechanical aortic valve replacement was in good condition after surgery,and was discharged with warfarin(2.25 mg·d-1 and 3 mg·d-1 alternatively)and INR 1.91 under the guidance of the pharmacist.After discharge,in addition to taking warfarin and other medication for heart failure treatment,he purchased Huangjing(astragalus)o-ral liquid at the pharmacy and took it everyday.Twelve days later,he developed recurrent gingival bleeding and INR was 4.95.Warfarin and astragalus oral liquid were stopped immediately,and warfarin was restarted 3 days later.INR was monitored and the dose was adjusted.The maintenance dose of warfarin was 3 mg·d-1 and the INR was around 2.0.It was considered that the abnor-mally elevated INR was caused by the interaction between warfarin and astragalus extract oral solution.

Obesity is a well-established risk factor for thrombotic events such as venous thromboembolism， and the alterations in pharmacokinetics induced by obesity pose challenges for anticoagulation management. This article systematically reviews the advances of the use of various anticoagulants in obese patients， and finds that the dosage of low-molecular-weight heparin needs to be adjusted according to preventive or therapeutic goals in severely obese patients， the preventive dose may be increased to 40 mg， q12 h or 0.5 mg/（kg·d）， while the therapeutic dose is recommended to be reduced to 0.8 mg/（kg·d）， q12 h. Direct oral anticoagulant drugs are safe and effective for general obese patients； in severely obese patients， standard doses of rivaroxaban or apixaban may be used， warranting cautious application and consideration for therapeutic drug monitoring. In special clinical scenarios such as obesity combined with trauma， pregnancy， advanced age， or bariatric surgery， anticoagulation strategies should be individualized， with close attention to monitoring. Future research should focus on optimizing anticoagulant regimens for special populations and addressing anticoagulation management in obese patients with other embolic diseases.

One patient who underwent mechanical aortic valve replacement was in good condition after surgery,and was discharged with warfarin(2.25 mg·d-1 and 3 mg·d-1 alternatively)and INR 1.91 under the guidance of the pharmacist.After discharge,in addition to taking warfarin and other medication for heart failure treatment,he purchased Huangjing(astragalus)o-ral liquid at the pharmacy and took it everyday.Twelve days later,he developed recurrent gingival bleeding and INR was 4.95.Warfarin and astragalus oral liquid were stopped immediately,and warfarin was restarted 3 days later.INR was monitored and the dose was adjusted.The maintenance dose of warfarin was 3 mg·d-1 and the INR was around 2.0.It was considered that the abnor-mally elevated INR was caused by the interaction between warfarin and astragalus extract oral solution.

AIM:To elucidate the effects of cefo-perazone-sulbactam on the pharmacokinetics of warfarin and the mechanism behind the enhance-ment of warfarin's efficacy.METHODS:Thirty-two rats were randomly assigned to four groups:WN(healthy rats after the gastric-administration of 0.125 mg/kg warfarin),WCN(healthy rats after the gastric-administration of 0.125 mg/kg warfarin and 0.3 g/kg cefoperazone-sulbactam),WO(a rat mod-el of biliary drainage after the gastric-administra-tion of 0.125 mg/kg warfarin),WCO(a rat model of biliary drainage after the gastric-administration of 0.125 mg/kg warfarin and 0.3 g/kg cefoperazone-sulbactam).Blood samples were collected at vari-ous time points from the femoral artery to deter-mine the plasma concentration of warfarin and from the tail vein to measure the International Nor-malized Ratio(INR).Warfarin levels were quanti-fied using LC/MS/MS,and pharmacokinetic param-eters were calculated using a non-compartmental model.The expression of P-glycoprotein(P-gp)in the ileal tissues of the WN and WCN groups was determined by Western blotting.RESULTS:Com-pared with the WN group,the WCN group demon-strated a significant increase in AUC0-t,Cmax,and Ka,and a notable decrease in CL/F,and INR values sig-nificantly increased.However,there was no signifi-cant difference in pharmacokinetic parameters and INR values between the WO group and the WCO group.Compared to the WN group,the WO group showed a significant reduction in AUC0-t,Cmax,and CL/F,with an obvious increase in t1/2.The INR of the WCN group was significantly higher than that of the WCO group after 6 hours.Western blotting re-sults indicated a 62.1％reduction in P-gp expres-sion in the ileum of the WCN group compared to the WN group(P＜0.01).CONCLUSION:Cefopera-zone-sulbactam significantly influences the pharma-cokinetic parameters of warfarin and enhances its pharmacological effect by inhibiting intestinal P-gp expression.Biliary drainage significantly affects the pharmacokinetics of warfarin rats,and there is no significant drug interaction between the two after biliary drainage.

Objective To investigate the clinical application of perioperative human serum albumin(HSA)in cardiac surgery in multiple regions in China,and to evaluate the rationality of its clinical application in conjunction with the clinical guidelines,in order to provide a reference for promoting the rational application of HSA.Methods The medical records of patients who underwent cardiac surgery from April to June 2019 in eight hospitals across the country were retrospectively collected.The statistical information on patients'general information,the dosage,course of treatment,and cost of HSA,and the serum albumin level before and after medication was analyzed to evaluate the use of HSA.Relevant evaluation criteria were established,and the rationality of its medication was evaluated.Results Data from a total of 449 patients were included for analysis,the appropriate rate of medication was 81.1％.The course of medication was mostly＞2-5 days and the total amount of HSA was mostly 50-99 g.The main purpose of medicaiton were improving colloid osmotic pressure,reducing exudation to improve interstitial edema,postoperative volume expansion.Conclusion Clinical attention should be paid to ensure the rational application of HSA in cardiac surgery during the perioperative period and prevent the abuse of blood products.

OBJECTIVE To provide a reference for the formulation of the antithrombotic treatment regimen of children with lower extremity deep venous thrombosis （DVT）. METHODS The clinical pharmacist participated in the antithrombotic treatment of a child with purpura nephritis complicated with lower extremity DVT and formulated an individualized dosing plan for the child. Considering that the child was readmitted to the hospital when DVT of the lower extremities did not relieve after anticoagulation therapy， it was recommended that thrombolytic therapy （Enoxaparin sodium injection 30 mg， q2 h， i.d.） be initiated after joint consultation by clinical pharmacists and physicians； catheter thrombolysis and thrombolytic drug therapy were simultaneously performed （intravenous infusion of 200 000 units of Urokinase for injection， per day）； great attention should be paid to the occurrence of adverse drug reactions in children， and the changes in coagulation indexes of the children should be monitored. For long-term anticoagulation therapy after discharge， clinical pharmacists recommended oral Rivaroxaban tablets 10 mg， qd， and adjusted the dose according to the weight change of the child. RESULTS The clinician adopted the pharmacist’s recommendations. After drug thrombolytic therapy， the child’s coagulation indicators returned to normal， the symptoms of lower extremity DVT improved significantly， and there were no adverse events of bleeding or other thrombotic events after discharge. CONCLUSIONS Clinical pharmacists can assist clinicians in formulating individualized treatment plans for children based on their expertise in pharmacy to ensure the rationality of medication use in children， which helps ensure the effectiveness and safety of medication for children.

AIM:To elucidate the effects of cefo-perazone-sulbactam on the pharmacokinetics of warfarin and the mechanism behind the enhance-ment of warfarin's efficacy.METHODS:Thirty-two rats were randomly assigned to four groups:WN(healthy rats after the gastric-administration of 0.125 mg/kg warfarin),WCN(healthy rats after the gastric-administration of 0.125 mg/kg warfarin and 0.3 g/kg cefoperazone-sulbactam),WO(a rat mod-el of biliary drainage after the gastric-administra-tion of 0.125 mg/kg warfarin),WCO(a rat model of biliary drainage after the gastric-administration of 0.125 mg/kg warfarin and 0.3 g/kg cefoperazone-sulbactam).Blood samples were collected at vari-ous time points from the femoral artery to deter-mine the plasma concentration of warfarin and from the tail vein to measure the International Nor-malized Ratio(INR).Warfarin levels were quanti-fied using LC/MS/MS,and pharmacokinetic param-eters were calculated using a non-compartmental model.The expression of P-glycoprotein(P-gp)in the ileal tissues of the WN and WCN groups was determined by Western blotting.RESULTS:Com-pared with the WN group,the WCN group demon-strated a significant increase in AUC0-t,Cmax,and Ka,and a notable decrease in CL/F,and INR values sig-nificantly increased.However,there was no signifi-cant difference in pharmacokinetic parameters and INR values between the WO group and the WCO group.Compared to the WN group,the WO group showed a significant reduction in AUC0-t,Cmax,and CL/F,with an obvious increase in t1/2.The INR of the WCN group was significantly higher than that of the WCO group after 6 hours.Western blotting re-sults indicated a 62.1％reduction in P-gp expres-sion in the ileum of the WCN group compared to the WN group(P＜0.01).CONCLUSION:Cefopera-zone-sulbactam significantly influences the pharma-cokinetic parameters of warfarin and enhances its pharmacological effect by inhibiting intestinal P-gp expression.Biliary drainage significantly affects the pharmacokinetics of warfarin rats,and there is no significant drug interaction between the two after biliary drainage.

Objective:To explore the efficacy and safety of sodium stibogluconate (SSG) and liposomal amphotericin (L-AmB) as well as their combination regimen in the treatment of Kala-azar (also known as visceral leishmaniasis) in China.Methods:Clinical data of patients with Kala-azar hospitalized in the First Hospital of Lanzhou University from January 2012 to December 2021 were collected, including patient demographic information, clinical characteristics of Kala-azar, previous treatment history, therapeutic drugs, clinical efficacy and adverse drug reactions (ADRs) in the treatment. The clinical characteristics, efficacy and occurrence of ADRs related to SSG and L-AmB in patients treated with SSG (SSG group) and L-AmB or SSG+L-AmB (L-AmB or SSG+L-AmB group) were analyzed by descriptive statistics.Results:A total of 44 patients were included in the analysis, including 25 males and 19 females; 25 were children (56.8%) and 19 were adults (43.2%). Thirty-seven patients (84.1%) were treated with SSG (SSG group), which was used as an initial treatment in 32 patients and was used also in previous treatment in 5 patients. Seven patients (15.9%) were treated with L-AmB, including 2 with L-AmB monotherapy and 5 with SSG+L-AmB, and all of them have been treated with SSG before. Among the 32 patients used SSG as initial treatments in the SSG group, 29 (90.6%) were clinically cured. All the 5 patients, who had been treated before, were also clinically cured after prolonged treatments. Seven patients in the L-AmB or SSG+L-AmB group were treated with a low-dose and long-term L-AmB regimen, and all of them were cured without Kala-azar recurrence. The common ADRs of SSG were abnormal liver function and elevated pancreatic enzymes; the common ADRs of L-AmB were hypokalemia and mild elevation of serum creatinine.Conclusions:The efficacy of SSG in initial treatment of patients with Kala-azar is more than 90%, and it can still be used as the preferred drug to treat Kala-azar. The monitoring of liver function and pancreatic enzymes should be paid attention to during the treatment. For patients that have been treated before, especially those with multiple Kala-azar recurrences, L-AmB or SSG+L-AmB should be advised. Low dose and long-term administration of L-AmB can obtain better efficacy and reduce the risk of ADR, and electrolytes and renal function should be monitored during the treatment.

A 59-year-old female patient with lung cancer developed chest tightness, shortness of breath, fatigue, and oliguria after 2 cycles of anlotinib standard regimen. Laboratory tests showed serum creatinine 995.5 μmol/L, urea nitrogen 18.9 mmol/L, blood uric acid 637 μmol/L, 24-hour urine output 400 ml, blood potassium 3.63 mmol/L, alanine aminotransferase (ALT) 957 U/L, aspartate aminotransferase (AST) 32 U/L, total bilirubin 38.8 μmol/L, and platelet count 49×10 9/L. Acute renal failure, liver dysfunction, and thrombocytopenia was diagnosed. The auxiliary examination results excluded the possible progression of underlying diseases. The clinical manifestations of the patient were time-dependent with oral administration of anlotinib. Anlotinib was discontinued and symptomatic treatments such as hemodialysis, liver protection, and diuresis were given. After 14 days, chest tightness, shortness of breath, and fatigue were significantly relieved. Laboratory tests showed serum creatinine 480.3 μmol/L, urea nitrogen 16.2 mmol/L, blood uric acid 414 μmol/L, 24-hour urine output 1 700 ml, blood potassium 3.18 mmol/L, ALT 45 U/L, AST 31 U/L, total bilirubin 37.4 μmol/L, and platelet count 81×10 9/L.

Objective:To explore the efficacy and safety of sodium stibogluconate (SSG) and liposomal amphotericin (L-AmB) as well as their combination regimen in the treatment of Kala-azar (also known as visceral leishmaniasis) in China.Methods:Clinical data of patients with Kala-azar hospitalized in the First Hospital of Lanzhou University from January 2012 to December 2021 were collected, including patient demographic information, clinical characteristics of Kala-azar, previous treatment history, therapeutic drugs, clinical efficacy and adverse drug reactions (ADRs) in the treatment. The clinical characteristics, efficacy and occurrence of ADRs related to SSG and L-AmB in patients treated with SSG (SSG group) and L-AmB or SSG+L-AmB (L-AmB or SSG+L-AmB group) were analyzed by descriptive statistics.Results:A total of 44 patients were included in the analysis, including 25 males and 19 females; 25 were children (56.8%) and 19 were adults (43.2%). Thirty-seven patients (84.1%) were treated with SSG (SSG group), which was used as an initial treatment in 32 patients and was used also in previous treatment in 5 patients. Seven patients (15.9%) were treated with L-AmB, including 2 with L-AmB monotherapy and 5 with SSG+L-AmB, and all of them have been treated with SSG before. Among the 32 patients used SSG as initial treatments in the SSG group, 29 (90.6%) were clinically cured. All the 5 patients, who had been treated before, were also clinically cured after prolonged treatments. Seven patients in the L-AmB or SSG+L-AmB group were treated with a low-dose and long-term L-AmB regimen, and all of them were cured without Kala-azar recurrence. The common ADRs of SSG were abnormal liver function and elevated pancreatic enzymes; the common ADRs of L-AmB were hypokalemia and mild elevation of serum creatinine.Conclusions:The efficacy of SSG in initial treatment of patients with Kala-azar is more than 90%, and it can still be used as the preferred drug to treat Kala-azar. The monitoring of liver function and pancreatic enzymes should be paid attention to during the treatment. For patients that have been treated before, especially those with multiple Kala-azar recurrences, L-AmB or SSG+L-AmB should be advised. Low dose and long-term administration of L-AmB can obtain better efficacy and reduce the risk of ADR, and electrolytes and renal function should be monitored during the treatment.