Individualized Decision-making for Anticoagulation Upon Pregnancy After Valve Replacement: A Clinical Reflection

OBJECTIVE To explore the role and challenges of clinical pharmacists in complex anticoagulation management through a case of multiple intrauterine fetal deaths in a pregnant patient after mechanical valve replacement.

METHODS Using the anticoagulation therapy process of this patient as an example, key contradictions were discussed, including the timing of warfarin transition, international normalized ratio target range, dosage adjustment of low-molecular-weight heparin, and monitoring frequency.

RESULTS In situations where the patient’s actual condition was inconsistent with guideline recommendations, clinical pharmacists should integrate evidence-based medicine with individualized risk assessment to assist in formulating appropriate medication strategies.

CONCLUSION Clinical pharmacists should play a central role in multidisciplinary collaboration and adopt an individualized anticoagulation management model characterized by dynamic evaluation, stratified intervention, and whole-process monitoring, thereby providing a reference for the clinical practice of similar complex cases.