目的探讨双瓣置换术后并发血小板减少的患者的抗凝治疗策略,为临床药师参与抗凝治疗提供参考。方法临床药师回顾性分析1例双瓣置换术后患者血小板减少的原因,结合药代动力学知识和相关文献资料,确定华法林初始剂量和目标国际标准化比值(INR),优化抗凝方案。结果患者血小板计数逐渐恢复正常;华法林抗凝治疗以5 mg为初始剂量,目标INR为1.8~2.5。经过五次剂量调整后以3.125 mg的维持剂量带药出院,出院时INR为1.5。结论临床药师参与可为患者提供更加安全、有效的治疗方案。Objective To explore the anticoagulation strategies for 1 double value replacement patient with thrombocytopenia, and to nsummarize the experience of clinical pharmacists participating in the anticoagulant therapy. Methods The clinical pharmacist retrospec-tively analyzed 1 patient with thrombocytopenia after double valve replacement. According to pharmacokinetic knowledge and related lit-eratures, the initial dose of warfarin and the target international normalize( INR) were determined and the anticoagulation regimen was optimized. Results The platelet counts gradually returned to normal; the warfarin anticoagulation was started with an initial dose of 5 mg,the target INR was 1. 8- 2. 5. After adjusting the dosage five times, the patient discharged with a maintenance dose of 3. 125 mg and an INR of 1. 5. Conclusion The participation of clinical pharmacists can provide more safe and effective treatment regimen for patients
