Causative Analysis and Pharmaceutical Monitoring of Abnormal INR Fluctuations Caused by Warfarin Anticoagulation Therapy in a Case of Heart Valve Replacement Surgery

OBJECTIVE  To explore the key points of pharmaceutical care of clinical pharmacists for patients with warfarin anticoagulant therapy after heart valve replacement, and to provide reference for pharmaceutical care of anticoagulant pharmacists in cardiac surgery.

METHODS  A case of abnormal international normalized ratio(INR) fluctuation during warfarin anticoagulation therapy in a patient after heart valve replacement was analyzed by clinical pharmacists from the aspects of gene polymorphism of warfarin therapy, disease status of perioperative patients, and perioperative concomitant medication, and suggestions and pharmaceutical care were put forward for postoperative drug treatment options, medication compliance education, and telephone follow-up after discharge.

RESULTS  Clinical pharmacists provided reasonable suggestions for clinicians to adjust the drug treatment regimen of the patients, and pharmaceutical care was implemented for them. One month after operation, no cardiovascular adverse events and adverse drug reactions occurred in the patients by telephone follow-up. Anticoagulation therapy was safe and effective, and the medication compliance of the patients was high.

CONCLUSION  For patients with abnormal INR fluctuation treated with anticoagulant therapy in cardiac perioperative period, clinical pharmacists should sort out the medication list in combination with the clinical status of patients, analyze the causes, and provide accurate pharmaceutical care.