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目的探讨临床药师在华法林安全使用中的作用。方法对1例心房颤动患者进行药学监护。患者入院第2天测凝血酶原时间(PT)33.5 s,国际标准化比值(INR)2.82;因感冒咳嗽加用复方甘草口服溶液,2 d后监测凝血四项显示PT升至38.4 s,INR升至3.38;临床药师分析患者所用药物中,复方甘草口服溶液可增强华法林的抗凝作用,建议停用华法林,行华法林基因多态性检测帮助确定华法林使用剂量。结果与结论患者INR值逐步回落,华法林调整至维持剂量每日2.5 mg。临床药师参与华法林相互作用的查找及个体化剂量的制定,保证患者的用药安全。
Objective To investigate the role of clinical pharmacists in the safe use of warfarin. Methods One patient with atrial fibrillation was given medical supervision. On the second day after admission, the prothrombin time (PT) was 33.5 s, and the international normalized ratio (INR) was 2.82. Four days after the onset of cold and cough with oral solution of licorice, four monitored coagulation showed PT increased to 38.4 s and INR To 3.38; clinical pharmacists analysis of patients with drugs, oral solution of compound licorice can enhance the anticoagulant effect of warfarin, it is recommended to disable warfarin, line warfarin gene polymorphism test to help determine the warfarin dose. RESULTS AND CONCLUSIONS Patients’ INR values gradually declined and warfarin adjusted to a sustained dose of 2.5 mg daily. Clinical pharmacists are involved in the search for warfarin interactions and the formulation of individualized doses to ensure patient safety of medication.