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华法林致深静脉血栓合并急性肾功能不全患者中毒性表皮坏死松解症的药学监护
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| 篇名： | 华法林致深静脉血栓合并急性肾功能不全患者中毒性表皮坏死松解症的药学监护 |
| TITLE： | Pharmaceutical care for toxic epidermal necrolysis in patients with deep vein thrombosis and acute renal insuffi-ciency induced by warfarin |
| 摘要： | 目的 为深静脉血栓合并急性肾功能不全患者使用华法林后出现中毒性表皮坏死松解症（TEN）的药学监护提供参考。方法临床药师参与1例深静脉血栓合并急性肾功能不全患者服用华法林后出现TEN的药学监护过程。临床药师根据Naranjo’s评估量表、国家药品不良反应监测中心不良反应因果关系判断标准判定该患者发生的TEN与华法林的关联性均为“很可能”；TEN评分（SCORTEN）为3分。针对患者出现的TEN，临床药师建议停用华法林，加强抗过敏处理，请烧伤整形外科协助诊治，同时加强监测；患者肾功能恢复后，建议将肝素更换为利伐沙班；患者感染控制后，建议停用抗感染药物。结果医师采纳临床药师建议。患者经治疗后好转，准予带药出院，出院后随访未再发生类似反应。结论华法林致深静脉血栓合并急性肾功能不全患者的TEN较为罕见，其机制不明确。临床应用华法林时需加强监测血常规、凝血图、肾功能、炎症指标；一旦怀疑为TEN，应立即停药并给予抗过敏等对症治疗，同时通过加强临床药师与临床医师的沟通、完善患者随访、优化治疗方案等，确保患者的用药安全。 |
| ABSTRACT： | OBJECTIVE To provide a reference for pharmaceutical care of patients with deep vein thrombosis and acute renal insufficiency that develop toxic epidermal necrolysis （TEN） after taking warfarin in clinical practice. METHODS Clinical pharmacists participated in the pharmaceutical care for a patient with deep vein thrombosis and acute renal insufficiency that developed TEN after taking warfarin. Based on the Naranjo’s assessment scale and the causality judgment criteria of the National Center for Adverse Drug Reaction Monitoring， the clinical pharmacists determined that the association between TEN and warfarin was “probable”. The TEN score （SCORTEN） was 3. Regarding the TEN that occurred in the patient， the clinical pharmacists recommended discontinuing warfarin， strengthening anti-allergic treatment， requesting assistance from the burn and plastic surgery department for diagnosis and treatment， and strengthening monitoring. When the patient’s renal function gradually recovered， it was recommended to replace heparin with rivaroxaban. After the infection was controlled， the anti-infective drug withdrawal was suggested. RESULTS The physician adopted the clinical pharmacist’s suggestions. The patient improved after treatment， was allowed to be discharged with medication， and no similar reactions recurred during follow-up after discharge. CONCLUSIONS The occurrence of TEN caused by warfarin in patients with deep vein thrombosis and acute renal insufficiency is relatively rare. The mechanism is unclear. During clinical application， it is necessary to strengthen monitoring of blood routine， coagulation profile， renal function， and inflammatory indicators. If TEN is suspected， the drug should be immediately discontinued， and symptomatic treatment， such as anti-allergic treatment should be given. Communication of clinical pharmacists with the physicians should be strengthened， patient follow-up should be improved， and the drug treatment plan should be optimized to ensure the safety of the patient’s medication. |
| 期刊： | 2025年第36卷第18期 |
| 作者： | 施超；舒德忠 |
| AUTHORS： | SHI Chao，SHU Dezhong |
| 关键字： | 华法林；中毒性表皮坏死松解症；深静脉血栓；药品不良反应；临床药师 |
| KEYWORDS： | warfarin； toxic epidermal necrolysis； deep |
| 阅读数： | 13 次 |
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