1例脑梗死伴房颤患者服用华法林期间INR值异常波动的病例分析

Analysis of a Case of Cerebral Infarction with Atrial Fibrillation Whose INR Fluctuated Abnormally During Taking Warfarin

关键词:  药学监护  华法林  国际标准化比值  相互作用  脑梗死  心房颤动

Key words:  pharmaceutical care  warfarin  INR  interaction  cerebral infarction  atrial fibrillation

摘要:

目的 对1例脑梗死合并房颤患者服用华法林期间INR值异常升高进行分析和干预，探讨临床药师在抗凝药物治疗中个体化药学服务的作用。方法 临床药师以1例脑梗死合并房颤患者的用药为切入点，全程参与药物治疗方案的选择，实施药学监护，对患者INR值异常升高情况进行分析和干预，从药动学和药效学的角度探讨了药物相互作用对华法林抗凝作用的影响机制。结果 药物和疾病状态对患者抗凝作用均有影响，头孢哌酮钠舒巴坦钠和丹红注射液是增加华法林抗凝作用的药物因素，肝功能异常则加剧了这一作用。结论 脑梗死合并房颤的老年患者往往用药较为复杂，临床药师应围绕患者的抗凝方案实施个体化的药学服务，关注中西药物的相互作用，以促进药物的安全合理使用，保障患者的用药安全。

Abstract:

OBJECTIVE To analyze and intervene the abnormal increase of the INR of warfarin in a patient with cerebral infarction complicated with atrial fibrillation, and to discuss the individual pharmacological service effect of clinical pharmacists in anticoagulant therapy. METHODS By participating in patients of cerebral infarction with atrial fibrillation with drug treatment options, analyzing INR increased abnormally, the clinical pharmacist explored the impact on pharmacokinetics and pharmacodynamics of warfarin and the mechanism affecting warfarin anticoagulation by drug interactions and disease state. RESULTS Cefoperidol sodium sulbactam sodium and Danhong injection were the drug factors enchancing the effect of warfarin anticoagyulation, and abnormal liver function was an other factor to aggravate this effect. CONCLUSION To the complexity of drug therapy in elderly patients of cerebral infarction with atrial fibrillation, the clinical pharmacist should carry out individualized pharmaceutical care, and focus on the interaction between Chinese and Western medicine, is beneficial to promote the rational use of drug, and ensure patients' safety.