临床药师参与1例疑似肝素相关性血小板减少的生物瓣膜术后患者的抗凝治疗药学实践

Rivaroxaban for Early Postoperative Anticoagulant Therapy After Bioprosthetic Valve Replacement: A Case Report of a Patient with Heparin-Induced Thrombocytopenia

关键词:  生物瓣膜置换  肝素相关性血小板减少  利伐沙班  直接口服抗凝药  超说明书用药  临床药师

Key words:  biological valve replacement  heparin-induced thrombocytopenia  rivaroxaban  direct oral anticoagulants  off-label drug use  clinical pharmacists

摘要:

目的 探索用于华法林禁忌患者生物瓣膜置换术后早期的口服抗凝治疗新方案。方法 临床药师全程参与1例生物瓣置换术后发生肝素相关性血小板减少(HIT)患者的抗凝治疗过程。针对患者抗凝治疗难点,临床药师提出在生物瓣膜置换术后早期(术后6个月内)采取阿加曲班桥接治疗剂量利伐沙班口服的个体化抗凝方案。结果 经患者知情同意后,治疗团队采纳药师意见。术后1、2、3和6个月的随访,患者血小板计数逐渐恢复,均未发生血栓及出血不良事件。结论 利伐沙班或可成为生物瓣膜置换术后早期血栓预防的备选药物之一；临床药师应发挥自身优势协助医师探索临床治疗新方案,同时完善患者随访确保患者用药安全。

Abstract:

ABSTRACT: OBJECTIVE　To explore a novel oral anticoagulation regimen for warfarin-contraindicated patients in the early postoperative period after bioprosthetic valve replacement. METHODS Clinical pharmacists participated in the anticoagulation management of a patient with heparin-induced thrombocytopenia (HIT) post bioprosthetic valve replacement. Addressing the anticoagulation challenge in this case, pharmacist proposed an individualized regimen: anticoagulation with therapeutic-dose oral rivaroxaban following argatroban within 6 months after surgery. RESULTS After obtaining informed consent, the treatment team adopted the pharmacists’ recommendation. Follow-up at 1, 2, 3, and 6 months postoperatively showed gradual platelet count recovery, with no thromboembolic or bleeding events. CONCLUSION　Rivaroxaban may serve as an alternative for thromboembolism prevention in the early postoperative period after bioprosthetic valve replacement. Clinical pharmacists should leverage their expertise to assist physicians in exploring innovative therapies and optimize follow-up to ensure medication efficacy and safety.