临床药师在支架内血栓患者抗血小板药物治疗中的作用
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摘要
支架内血栓是经皮冠状动脉介入治疗的严重并发症,虽然其发生率较低,但是一旦发生后果却很严重。临床药师通过参与1例支架内血栓患者的药物治疗,分析患者发生支架内血栓的可能原因并进行药物调整,分析并处理替格瑞洛的不良反应,分析讨论此类患者的抗血小板治疗方案和围经皮冠状动脉介入治疗术期的药学监护。旨在提高支架术后患者的药物治疗效果,减少并发症及药物不良反应的发生,改善患者的预后。
Intrastent thrombosis(IST) is a serious complication in percutaneous coronary intervention(PCI). Though the incidence is low, the consequence is serious once it happens. In this paper, clinical pharmacists participated in the therapy plan for one patient with IST, analyzed the possible causes of IST, adjusted drugs or dosages and put forward suggestions when adverse reactions to ticagrelor appeared. Clinical pharmacists analyzed antiplatelet therapies and perioperative care for PCI. to improve the therapeutic efficacy and prognosis, and reduce the complications in patients after stenting.
Intrastent thrombosis(IST) is a serious complication in percutaneous coronary intervention(PCI). Though the incidence is low, the consequence is serious once it happens. In this paper, clinical pharmacists participated in the therapy plan for one patient with IST, analyzed the possible causes of IST, adjusted drugs or dosages and put forward suggestions when adverse reactions to ticagrelor appeared. Clinical pharmacists analyzed antiplatelet therapies and perioperative care for PCI. to improve the therapeutic efficacy and prognosis, and reduce the complications in patients after stenting.
引文
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[9]张胜,孙建辉,周学中.替格瑞洛和双倍剂量氢氯吡格雷治疗氢氯吡格雷抵抗患者的有效性及安全性[J].心脏杂志,2017,22(1):554-557.
[10]Wei CL,Waskell LA,Watkins PB,et al.Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation a new drug-drug interaction[J].Circulation,2003,107(1):32-37.
[11]Neubauer H,Günesdogan B,Hanefeld C,et al.Lipophilic statins interfere with the inhibitory effects of clopidogrel on platelet function-a flow cytometry study[J].Eur Heart J,2003,24(19):1744-1749.
[12]Saw J,Steinhubl SR,Berger PB,et al.Lack of adverse clopidogrel-atorvastatin clinical interaction from secondary analysis of a randomized,placebo-controlled clopidogrel trial[J].Circulation,2003,108(8):921-924.
[13]Piorkowski M,Weikert U,Schwimmbeck PL,et al.ADP induced platelet degranulation in healthy individuals is reduced by clopidogrel after pretreatment with atorvastatin[J].Thromb Haemostasis,2004,92(3):614-620.
[2]王京京,张晓春.冠脉支架植入术后急性或亚急性支架内血栓形成患者的护理体会[J].中国医科大学学报,2014,43(7):666-667.
[3]Simon T,Verstuyft C,Marykrause M,et al.Genetic determinants of response to clopidogrel and cardiovascular events[J].N Engl J Med,2009,360(4):363-375.
[4]Scott SA,Sangkuhl K,Shuldiner AR,et al.Pharm GKB summary:very important pharmacogene information for cytochrome P450,family 2,subfamily C,polypeptide19[J].Pharmacogenet Genom,2012,22(2):159-162.
[5]李广华,李阳华,范小斌,等.血栓弹力图法和光学比浊法监测PCI术后氯吡格雷疗效的对比研究[J].临床输血与检验,2017,19(1):59-63.
[6]刘晓雨,贾国伟,孙荣国,等.替格瑞洛治疗氯吡格雷低反应患者的有效性及安全性分析[J].临床荟萃,2016,31(4):403-406.
[7]Choi H,Ryu JH,Seo H,et al.Is a high maintenance dose of clopidogrel suitable for overcoming clopidogrel resistance in patients?[J].Int J Clin Pharm,2015,37(5):758-761.
[8]Dridi NP,Johansson PI,Clemmensen P,et al.Prasugrel or double-dose clopidogrel to overcome clopidogrel low-response-the TAILOR(Thrombocytes and individualization of oral antiplatelet therapy in percutaneous coronary intervention)randomized trial[J].Platelets,2014,25(7):506-512.
[9]张胜,孙建辉,周学中.替格瑞洛和双倍剂量氢氯吡格雷治疗氢氯吡格雷抵抗患者的有效性及安全性[J].心脏杂志,2017,22(1):554-557.
[10]Wei CL,Waskell LA,Watkins PB,et al.Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation a new drug-drug interaction[J].Circulation,2003,107(1):32-37.
[11]Neubauer H,Günesdogan B,Hanefeld C,et al.Lipophilic statins interfere with the inhibitory effects of clopidogrel on platelet function-a flow cytometry study[J].Eur Heart J,2003,24(19):1744-1749.
[12]Saw J,Steinhubl SR,Berger PB,et al.Lack of adverse clopidogrel-atorvastatin clinical interaction from secondary analysis of a randomized,placebo-controlled clopidogrel trial[J].Circulation,2003,108(8):921-924.
[13]Piorkowski M,Weikert U,Schwimmbeck PL,et al.ADP induced platelet degranulation in healthy individuals is reduced by clopidogrel after pretreatment with atorvastatin[J].Thromb Haemostasis,2004,92(3):614-620.
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