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PCI术后亚急性支架内血栓形成患者的个体化抗血小板治疗分析及药学监护
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| 篇名： | PCI术后亚急性支架内血栓形成患者的个体化抗血小板治疗分析及药学监护 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在经皮冠状动脉介入治疗（PCI）术后亚急性支架内血栓形成患者个体化抗血小板治疗中的作用。方法：临床药师参与1例心肌梗死合并糖尿病患者的治疗过程，该患者于PCI术后第4天发生亚急性支架内血栓形成，临床药师通过综合分析其病变复杂程度、支架内血栓发生时间、植入支架数量、合并疾病等因素，建议行氯吡格雷相关基因[细胞色素P450（CYP）2C19]检测；根据其检测结果（CYP2C19*1/*2），建议在原双联抗血小板治疗的基础上加用西洛他唑片50 mg，po，bid，同时加用前列地尔注射液10 μg，ivgtt，qd改善微循环，并行疗效评价、不良反应监测等药学监护以及用药注意事项、饮食调整等用药教育。结果：医师采纳临床药师建议，患者病情好转出院。出院后，仍坚持使用阿司匹林+氯吡格雷+西洛他唑三联抗血小板治疗，患者病情稳定。结论：药物代谢酶是引起抗血小板药物效应和毒性个体差异的重要原因，其基因多态性与患者的临床转归和终点事件密切相关。临床药师应发挥自身专业所长，协助医师查阅和解读相关信息，在综合考虑患者病情、合并疾病、基因型等因素后，制订和调整个体化抗血小板治疗方案，保证患者用药的安全、有效。 |
| ABSTRACT： | OBJECTIVE： To investigate the role of clinical pharmacists in individualized antiplatelet therapy for a patient with subacute stent thrombosis after PCI. METHODS： Clinical pharmacists participated in the therapy for a myocardial infarction patient with diabetes， and the patient suffered from subacute stent thrombosis at the fourth day after PCI. Clinical pharmacists suggested performing clopidogrel-related gene detection [Cytochrome P450（CYP）2C19] through comprehensively analyzing the complexity of the lesion， the time of stent thrombosis， the number of stent implantations and combined diseases， etc. According to detection result （CYP2C19*1/*2）， clinical pharmacists suggested to additionally use Cilostazol tablets 50 mg，po，bid， on the basis of previous dual antiplatelet therapy； additionally use Alprostadil injection 10 μg，ivgtt，qd to improve microcirculation. Pharmaceutical care as therapeutic evaluation， ADR monitoring were performed， and medication education as medication notes and dietary adjustments were also provided. RESULTS： Physicians adopted the suggestions of clinical pharmacists； the patient was recovered and discharged from hospital. After discharge， the disease condition kept stable due to persistent aspirin+clopidogrel+cilostazol triple antiplatelet therapy. CONCLUSIONS： Drug metabolizing enzyme is an important cause of individual differences in antiplatelet effects and toxicity， and its gene polymorphism is closely related with clinical outcome and terminal event. Clinical pharmacists should play professional skill to assist physician to access and interpret relevant information， and formulate and adjust individualized antiplatelet therapy after considering disease condition， combined diseases and genotypes， so as to guarantee safe and effective drug use. |
| 期刊： | 2017年第28卷第32期 |
| 作者： | 董丽梅，罗宏丽，陈竹，王国俊 |
| AUTHORS： | DONG Limei，LUO Hongli，CHEN Zhu，WANG Guojun |
| 关键字： | 心肌梗死；糖尿病；亚急性支架内血栓形成；CYP2C19基因多态性；抗血小板；药学监护 |
| KEYWORDS： | Myocardial infarction； Diabetes； Subacute stent thrombosis； CYP2C19 gene polymorphisms； Antiplatelet； Pharmaceutical care |
| 阅读数： | 362 次 |
| 本月下载数： | 4 次 |
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