Pharmaceutical care and literature review of type Ⅱ thrombocytopenia induced by anticoagulant therapy on a patient with acute pulmonary embolism
-
摘要: 目的 探讨低分子肝素诱导的Ⅱ型血小板减少症（HIT）患者的药学服务要点，从而为临床药师参与此类患者的临床治疗提供参考。 方法 临床药师对1例急性肺栓塞使用低分子肝素钠抗凝治疗导致Ⅱ型血小板减少症的患者进行用药分析及药学监护。检索近年来国内外的相关文献，并结合本病例进行相关性评价，帮助临床医生制订治疗方案。 结果 急性肺栓塞患者治疗安全有效，血小板计数等指标恢复正常。 结论 临床药师应用循证医学证据，充分发挥药学专业特长，积极参与临床Ⅱ型HIT患者的治疗监护，提高药物治疗的安全有效性。
-
关键词:
- 急性肺栓塞 /
- 肝素诱导的血小板减少症 /
- 临床药师 /
- 药学监护
Abstract: Objective To explore the key points of pharmaceutical care in patients with thrombocytopenia (HIT) induced by low molecular weight heparin,and to provide reference for clinical pharmacists to participate in the clinical treatment of such patients. Methods Pharmaceutical care was carried out by clinical pharmacists for a patient diagnosed with acute pulmonary embolism who developed progressive thrombocytopenia in the treatment of low molecular weight heparin.To assist clinicians to develop treatment options,literatures published in domestic and international were reviewed and the ADRs relevance of this example were evaluated. Results Pharmaceutical care was applied to the acute pulmonary embolism patient and his platelet count returned to normal eventually. Conclusion Clinical pharmacists should give full play to the expertise of pharmacy specialty,actively participate in the treatment and monitoring of clinical HIT patients,and improve the safety and efficacy of drug therapy. -
[1] SALTER B S,WEINER M M,TRINH M A,et al.Heparin-induced thrombocytopenia:a comprehensive clinical review[J].J Am Coll Cardiol,2016,67(21):2519-2532. [2] PRINCE M,WENHAM T.Heparin-induced thrombocytopaenia[J].Postgrad Med J,2018,94(1114):453-457. [3] 颜明明,刘利月,戴婷婷,等.低分子肝素类药物的临床应用[J].中国医药指南,2018,16(18):39-40. [4] 谷文静,张磊.肝素诱导的血小板减少症研究进展[J].临床血液学杂志,2017,30(1):5-7. [5] RAUOVA L,AREPALLY G,PONCZ M,et al.Molecular and cellular pathogenesis of heparin-induced thrombocytopenia(HIT)[J].Autoimmun Rev,2018,17(10):1046-1052. [6] 中国医师协会心血管内科医师分会血栓防治专业委员会.肝素诱导的血小板减少症中国专家共识(2017)[J].中华医学杂志,2018,98(6):408-417. [7] WARKENTIN T E, SAFYAN E L, LINKINS L A. Heparin induced thrombocytopenia presenting as bilateral adrenal hemorrhages[J].N Engl J Med,2015,372(5):492-494. [8] 任静,翟振国,门剑龙.肝素诱导的血小板减少症临床诊疗的循证进展[J].中华医学杂志,2017,97(46):3667-3670. [9] 蒋媛,史桂玲,张惠娟,等.1例低分子肝素钙诱导血小板减少症的药学监护[J].医药导报,2017,36(4):406-409. [10] SCHINDEWOLF M,SCHWANER S,WOLTER M,et al.Incidence and causes of heparin-induced skin lesions[J].CMAJ,2009,181(8):477-481. [11] GREINACHER A.Heparin-induced thrombocytopenia[J].N Engl J Med,2015,373(19):1883-1884. [12] KONSTANTINIDES S V,TORBICKI A,AGNELLI G,et al.Corrigendum to:2014 ESC guidelines on the diagnosis and manangement of acute pulmonary embolism[J].Eur Heart J,2014,36(39):2642. [13] 朱愿超,赵紫楠,梁良,等.北京医院786例患者利伐沙班的应用分析[J].临床药物治疗杂志,2018,16(4):58-61. [14] 郑煜,王齐兵,李晓哗.Ⅱ型肝素诱导血小板减少症的危险因素分析[J].上海医药,2016(37)9:46-48. -
点击查看大图
计量
- 文章访问数: 4060
- HTML全文浏览量: 466
- PDF下载量: 307
- 被引次数: 0
下载:
