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

陈慧; 周强; 孙磊; 王常田; 魏萌

doi:10.13748/j.cnki.issn1007-7693.20252935

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

Pharmaceutical Practice of Clinical Pharmacist in Anticoagulant Therapy for a Postoperative Bioprosthetic Valve Patient with Suspected Heparin-induced Thrombocytopenia

摘要

摘要:
目的通过报道1例发生肝素相关性血小板减少的生物瓣膜置换术后患者的抗凝治疗全过程，为存在华法林禁忌的患者口服抗凝方案的选择提供参考。
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)采取阿加曲班桥接利伐沙班口服的个体化抗凝方案。
结果经患者知情同意后，医疗团队采纳药师意见。术后1、2、3和6个月门诊随访显示，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:
OBJECTIVE To present a case of suspected heparin-induced thrombocytopenia following bioprosthetic valve replacement, offering a reference for the selection of oral anticoagulation regimens in patients with contraindications to warfarin.
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 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.

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