OBJECTIVE: To investigate the role of clinical pharmacists in the individual anticoagulation of warfarin for the patients with lower extremity venous thrombosis (LEVT) and pulmonary arterial thromboembolism (PATE). METHODS: Clinical pharmacists participated in individual anticoagulation of warfarin for the patients with LEVT and PATE. It was suggested to detect the gene type of the patient. According to the results of gene test [cytochrome P450 (CYP)2C9*1*1 and vitamin K epoxide reductase complex subunit Ⅰ] and the dose recommended by FDA based on the patient’s gene, the initial dose of warfarin (3.125 mg,once a day) was determined according to the patient’s living habits, height and body mass. Then the maintenance dose of warfarin (the maintenance dose of warfarin was 2.5 mg and 3.125 mg, once a day, alternately taken every other day) was calculated according to the warfarin maintenance dose prediction formula established by Warfarin Pharmaeogenetics Consortium. Pharmaceutical monitoring was conducted, such as INR, prothrombin time and bleeding event monitering. RESULTS: Physicians adopted the suggestion of clinical pharmacists. The maintenance dose of warfarin was 2.5 mg and 3.125 mg, once a day, alternately taken every other day. It was suggested to give Flucloxacillin sodium injection which had less influence on warfarin. The patient recovered well and was discharged. CONCLUSIONS: Based on pharmacogenomics, clinical pharmacists participate in the formulation of individualized anticoagulant regimens for patients, which promote TNR ralue of patients, reduce the risk of early postoperative thromboembolism, and further ensure the safety of drug use in patients.
Evaluation of Anticoagulant Effects of Clinical Pharmacist Management in Anticoagulation Clinic
Participation of clinical pharmacists in pharmaceutical care for a patient with Mycobacterium abscess infection after the resection of intervertebral schwannoma
临床药师参与1 例高龄患者治疗的药物重整
基于问题学习教学法用于临床药师培训的实践与探索
Related Author
LI Chenlu
PAN Hongming
SHEN Lirong
SHAO Hua
LI Shuyue
HUI Xiang
JIN Yuanxiang
WANG Juan
Related Institution
Dept. of Pharmacy, Second Affiliated Hospital, Army Medical University
Dept. of Pharmacy, Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University