CAJ | 학술논문

目的：探索长期接受抗凝治疗患者围手术期的抗凝治疗策略,体现临床药师参与药物治疗的作用。方法：回顾临床药师参与1例长期接受华法林抗凝治疗患者围手术期抗凝方案,结合相关的文献资料,从药物的选择、使用时机、剂量、疗程等方面进行分析。结果：临床药师结合药动学知识,制定抗凝方案,最大程度上降低了患者出血和栓塞的风险。结论：围手术期应该至少提前5d停用华法林,并监测国际标准化比值(INR)；术后无继续出血可在12h内开始使用低分子肝素,同时服用华法林,并监测INR,待达标后停用低分子肝素。如果患者要连续进行多次手术,则在整个手术期间建议使用低分子肝素进行抗凝。
목적：탐색장기접수항응치료환자위수술기적항응치료책략,체현림상약사삼여약물치료적작용。방법：회고림상약사삼여1례장기접수화법림항응치료환자위수술기항응방안,결합상관적문헌자료,종약물적선택、사용시궤、제량、료정등방면진행분석。결과：림상약사결합약동학지식,제정항응방안,최대정도상강저료환자출혈화전새적풍험。결론：위수술기응해지소제전5d정용화법림,병감측국제표준화비치(INR)；술후무계속출혈가재12h내개시사용저분자간소,동시복용화법림,병감측INR,대체표후정용저분자간소。여과환자요련속진행다차수술,칙재정개수술기간건의사용저분자간소진행항응。
Objective:To explore the anticoagulant strategies during perioperative period for the patients with long-term anticoagu-lation therapy to show the important role of clinical pharmacist in drug treatment. Methods:The anticoagulant regimen during the peri-operative period participated by clinical pharmacists for one patient with long-term use of warfarin was reviewed, and combined with the related literatures, the drug choice, the administration time, dosage and treatment course were analyzed. Results: The clinical phar-macists could optimize the anticoagulant regimen by using the pharmacokinetic knowledge to decrease the risk of hemorrhage and embol-ism to the largest extent. Conclusion:During the perioperative period, warfarin should be withdrawn at least 5 days before the opera-tion, and the international normalize ratio ( INR) should be monitored. After the operation and no further bleeding, low molecular weight heparin combined with warfarin can be used in 12h, and INR should be monitored. Low molecular weight heparin can be with-drawn till the standard is reached. If the patient undergoes operation for many times, low molecular weight heparin is suggested to be used for anticoagulation during the whole operation period.