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使用华法林抗凝的肺栓塞患者出血与止血治疗矛盾的处理方法
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| 篇名： | 使用华法林抗凝的肺栓塞患者出血与止血治疗矛盾的处理方法 |
| TITLE： | |
| 摘要： | 目的：讨论使用华法林抗凝的肺栓塞患者出血与止血治疗矛盾的处理方法。方法：分析1例使用华法林抗凝致国际标准化比值（INR）异常升高的肺栓塞患者的治疗过程，总结其使用华法林抗凝的出血风险和血栓栓塞风险的评估及处理方法，并结合国内外相关指南和资料对该病例进行分析。结果：临床医师和药师参考患者的INR，结合房颤出血评分系统（HAS-BLED）、Caprini评分表、《华法林抗凝治疗的中国专家共识》、《内科住院患者静脉血栓栓塞症预防的中国专家建议》及《美国胸科医生协会非手术患者静脉血栓栓塞预防指南》等指南，及时调整华法林钠片的剂量；该患者经抗凝、止咳平喘、化痰等对症治疗后，病情好转，带药出院。结论：该类患者出血与止血的风险评估及其处理可结合HAS-BLED、Caprini评分表及相关指南，但目前尚存在评价方法不足、大量高级别证据及定量研究缺乏等问题，有待于积极开展多中心临床研究及相互作用定量研究，开发适用于我国患者的风险评估方法，为临床治疗提供高质量、有价值的决策依据。 |
| ABSTRACT： | OBJECTIVE： To discuss the solution of therapeutic contradictions of bleeding and hemostasis in pulmonary embolism patients receiving warfarin anticoagulation. METHODS： The risk evaluation and dissolution of bleeding and embolism induced by warfarin anticoagulation were summarized by analyzing therapeutic duration of INR abnormal elevation in a pulmonary embolism patient receiving warfarin anticoagulation. Case analysis was based on foreign and domestic guideline and information. RESULTS： Referring to INR value， based on HAS-BLE， Caprini scale， China Expert Consensus on Anticoagulant Therapy of Warfarin， China Expert Suggestions on Prevention of Venous Thrombosis in Internal Inpatients and Guidelines of Prevention of VTE in Nonsurgical Patients of American College of Chest Physicians， clinical pharmacists and physicians adjusted the dose of Warfarin tablet timely. The patient was recovered after symptomatic treatment of anticoagulation， relieving cough and asthma， reducing phlegm， etc.， and then disagreed from hospital with drugs. CONCLUSIONS： The risk of bleeding and embolism for this type patients can be evaluated and resolved on the basis of HAS-BLED， Caprini scale and relevant guidelines. At present， there still are some problems as deficient evaluation method， lack of large-scale high-level evidence and quantitative study. It is needed to carry out multiple center clinical study and drug interaction quantitative study actively， and develop suitable risk evaluation method so as to provide high-quality and valuable decision-making evidence. |
| 期刊： | 2016年第27卷第20期 |
| 作者： | 唐凤敏，徐红冰 |
| AUTHORS： | TANG Fengmin，XU Hongbing |
| 关键字： | 肺栓塞；华法林；抗凝；出血；止血 |
| KEYWORDS： | Pulmonary embolism； Warfarin； Anticoagulation； Bleeding； Hemostasis |
| 阅读数： | 525 次 |
| 本月下载数： | 7 次 |
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