Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency

HUANG Yongjia; JIANG Dequan; DING Ling; LIU Jie; HE Xiaoyan; LI Xiaoya; HUANG Wanting; LI Jindou

doi:10.6039/j.issn.1001-0408.2023.18.18

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Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency

更新时间：2025-09-26

- Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency
- ZHONGGUO YAOFANG Vol. 34, Issue 18, Pages: 2274-2277(2023)
- 作者机构：
  
  1.重庆市江津区中心医院药学部，重庆　402260
  2.重庆市江津区中心医院胃肠外科，重庆　402260
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.18.18
  CLC： R969.3;R972
- Received：15 February 2023，
  
  Revised：2023-07-16，
  
  Accepted：26 July 2023，
  
  Published：30 September 2023
- 稿件说明：
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黄永佳,江德全,丁玲,等.1例复杂性静脉血栓栓塞症合并急性肾功能不全患者的抗凝药物治疗管理[J].中国药房,2023,34(18):2274-2277.

HUANG Yongjia,JIANG Dequan,DING Ling,et al.Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency[J].ZHONGGUO YAOFANG,2023,34(18):2274-2277.
黄永佳,江德全,丁玲,等.1例复杂性静脉血栓栓塞症合并急性肾功能不全患者的抗凝药物治疗管理[J].中国药房,2023,34(18):2274-2277. DOI： 10.6039/j.issn.1001-0408.2023.18.18.

HUANG Yongjia,JIANG Dequan,DING Ling,et al.Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency[J].ZHONGGUO YAOFANG,2023,34(18):2274-2277. DOI： 10.6039/j.issn.1001-0408.2023.18.18.

摘要

目的

为复杂性静脉血栓栓塞症（VTE）合并急性肾功能不全患者的安全用药提供参考。

方法

临床药师参与1例复杂性VTE合并急性肾功能不全患者的抗凝药物治疗管理，通过患者病史、实验室检查结果等，评估其属于血栓形成高危和出血高危患者；结合该患者血栓复杂程度和肾功能不全，建议其在血栓急性期（发病5～21 d）选用依诺肝素钠，随后桥接华法林口服抗凝治疗；针对该患者抗凝不达标（国际标准化比值目标范围为2～3），建议增加华法林剂量并行华法林药物基因检测，根据基因分型调整华法林剂量；同时制定抗凝监护计划，确保抗凝治疗的安全性。

结果

医师采纳了临床药师的建议。患者住院抗凝治疗期间未发生出血或血栓栓塞加重等不良事件，抗凝达标，准予带药出院。

结论

临床药师通过参与复杂性VTE合并急性肾功能不全患者的抗凝药物治疗管理，协助医师制定个体化抗凝方案，促进了患者抗凝治疗达标，确保了其用药安全、有效。

Abstract

OBJECTIVE

To provide a reference for the safe use of drugs in patients with complex venous thromboembolism （VTE） and acute renal insufficiency.

METHODS

Clinical pharmacists participated in the management of anticoagulant therapy for a patient with complex VTE complicated with acute renal insufficiency， and evaluated the patient as high-risk thrombosis and bleeding based on their medical history， laboratory test results， etc.； combined with the complexity of thrombosis and renal insufficiency， clinical pharmacists suggested that enoxaparin sodium should be used in the acute stage of thrombosis （5 to 21 days after onset）， and then warfarin should be adopted for oral anticoagulation treatment. Because the patient’s anticoagulation was not up to the standard （the target range of the international normalized ratio was 2-3）， clinical pharmacists suggested increasing the warfarin dose， detecting the warfarin metabolism genotype， and adjusting the warfarin dose according to the genotype； at the same time， clinical pharmacists developed an anticoagulation monitoring plan to ensure the safety of anticoagulation treatment.

RESULTS

Doctors had adopted all the recommendations of clinical pharmacists. The patient did not experience adverse events such as bleeding or worsening of thromboembolism during anticoagulation in the hospital. When the anticoagulation met the standards， the patient was allowed to be discharged with medication.

CONCLUSIONS

By participating in the anticoagulation treatment management of patients with complex VTE and acute renal insufficiency， clinical pharmacists have assisted doctors in formulating personalized anticoagulation plans to promote the compliance with the anticoagulation treatment standard and ensure the safety and effectiveness of medication for patients.

关键词

Keywords

references

国家卫生健康委办公厅 . 关于印发2021年国家医疗质量安全改进目标的通知 [EB/OL ] . [ 2023-07-16 ] . https：//www.gov.cn/zhengce/zhengceku/2021-02/22/content_5588240.htm https://www.gov.cn/zhengce/zhengceku/2021-02/22/content_5588240.htm .

张文一，李帅，张璇，等 . 住院患者VTE标准化防治管理体系构建与应用 [J ] . 中国卫生质量管理， 2022 ， 29 （ 7 ）： 22 - 25，31 .

李晓强，张福先，王深明 . 深静脉血栓形成的诊断和治疗指南：第三版 [J/OL ] . 中国血管外科杂志（电子版）， 2017 ， 9 （ 4 ）： 250 - 257 [ 2023-07-16 ] . https：//kns.cnki.net/kcms2/ article/abstract?v https://kns.cnki.net/kcms2/article/abstract?v ＝3uoqIhG 8 C 44

YLTlOAiTRKibYlV 5 Vjs-7i0-kJR0HYBJ80QN9L51zrPxronVSrxWn4PxyAlZByG-Atpx 4 D 2 EH8 VYSGICwOSccHX&uniplatform＝NZKPT . DOI： CNKI：SUN：XGWK.0.2017-04-005 http://dx.doi.org/CNKI：SUN：XGWK.0.2017-04-005 .

BOURJEILY G ， PAIDAS M ， KHALIL H ， et al . Pulmonary embolism in pregnancy [J ] . Lancet ， 2010 ， 375 （ 9713 ）： 500 - 512 .

KEARON C ， AKL E A ， ORNELAS J ， et al . Antithrombotic therapy for VTE disease：CHEST guideline and expert panel report [J ] . Chest ， 2016 ， 149 （ 2 ）： 315 - 352 .

中华医学会临床药学分会，中国药学会医院药学专业委员会，中华医学会肾脏病学分会 . 碘对比剂诱导的急性肾损伤防治的专家共识 [J ] . 中华肾脏病杂志， 2022 ， 38 （ 3 ）： 265 - 288 .

ORTEL T L ， NEUMANN I ， AGENO W ， et al . American Society of Hematology 2020 guidelines for management of venous thromboembolism：treatment of deep vein thrombosis and pulmonary embolism [J ] . Blood Adv ， 2020 ， 4 （ 19 ）： 4693 - 4738 .

VAHANIAN A ， BEYERSDORF F ， PRAZ F ， et al . 2021 ESC/EACTS guidelines for the management of valvular heart disease [J ] . Eur Heart J ， 2022 ， 43 （ 7 ）： 561 - 632 .

LIP G Y H ， BANERJEE A ， BORIANI G ， et al . Antithrombotic therapy for atrial fibrillation：chest guideline and expert panel report [J ] . Chest ， 2018 ， 154 （ 5 ）： 1121 - 1201 .

FERRO J M ， BOUSSER M G ， CANHÃO P ， et al . European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis-endorsed by the European Academy of Neurology [J ] . Eur J Neurol ， 2017 ， 24 （ 10 ）： 1203 - 1213 .

ALKHOULI M ， MORAD M ， NARINS C R ， et al . Inferior vena cava thrombosis [J ] . JACC Cardiovasc Interv ， 2016 ， 9 （ 7 ）： 629 - 643 .

STEFFEL J ， COLLINS R ， ANTZ M ， et al . 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation [J ] . Europace ， 2021 ， 23 （ 10 ）： 1612 - 1676 .

中华医学会心电生理和起搏分会，中国医师协会心律学专业委员会，中国房颤中心联盟心房颤动防治专家工作委员会，等 . 心房颤动：目前的认识和治疗建议：2021 [J ] . 中华心律失常学杂志， 2022 ， 26 （ 1 ）： 15 - 88 .

CONSORTIUM I W P ， KLEIN T E ， ALTMAN R B ， et al . Estimation of the warfarin dose with clinical and pharmacogenetic data [J ] . N Engl J Med ， 2009 ， 360 （ 8 ）： 753 - 764 .

TATARUNAS V ， JANKAUSKIENE L ， KUPSTYTE N ， et al . The role of clinical parameters and of CYP2C19 G681 and CYP4F2 G1347A polymorphisms on platelet reacti-vity during dual antiplatelet therapy [J ] . Blood Coagul Fibrinolysis ， 2014 ， 25 （ 4 ）： 369 - 374 .

KUPSTYTE N ， ZALIUNAS R ， TATARUNAS V ， et al . Effect of clinical factors and gene polymorphism of CYP2C19*2，*17 and CYP4F2*3 on early stent throm-bosis [J ] . Pharmacogenomics ， 2015 ， 16 （ 3 ）： 181 - 189 .

NAKAMURA K ， OBAYASHI K ， ARAKI T ， et al . CYP4F2 gene polymorphism as a contributor to warfarin maintenance dose in Japanese subjects [J ] . J Clin Pharm Ther ， 2012 ， 37 （ 4 ）： 481 - 485 .

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