Pharmaceutical Care on One Case of Gastrointestinal Hemorrhage Caused by Anticoagulant Drugs in a Patient with Percutaneous Coronary Intervention Combined with Pulmonary Embolism

Abstract

Abstract: Objective To explore how clinical pharmacists to use antithrombotic drugs for patients with pulmonary embolism after percutaneous coronary intervention operation to carry out pharmaceutical care.Methods By studying the antithrombotic drugs used in the patient, the possible causes of gastrointestinal hemorrhage were analyzed.Results The application of anticoagulant and antiplatelet drugs in the quadruple is the main cause of the symptoms of gastrointestinal hemorrhage in this patient.Conclusion The application of anticoagulants should be based on the risk of bleeding and the types of anticoagulant drugs for patients with heparin and wafarin indication when aspirin and clopidogrel are applied after percutaneous coronary intervention.

Key words: percutaneous coronary intervention, pulmonary embolism, gastrointestinal hemorrhage, pharmaceutical care

CLC Number:

R972.7

LI Zhi-cheng. Pharmaceutical Care on One Case of Gastrointestinal Hemorrhage Caused by Anticoagulant Drugs in a Patient with Percutaneous Coronary Intervention Combined with Pulmonary Embolism[J]. Chinese Journal of Pharmacovigilance, 2018, 15(5): 308-311.

References

[1] 中华医学会心血管病学分会介入心脏病学组.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志，2016,4（5）：382-400.
[2] 中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识(2015)[J].中华心血管病杂志，2015，44（3）：197-211.
[3] Subherwal S,Bach R G,Chen A Y,et al.Baseline risk of major bleeding in non-ST-segment-ele-vation myocardial infarction: the CRUSADE(Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Eariy implementation of the ACC/AHA Guidelines)Bleeding Score[J].Circulation，2009，119（14）:1873-1882.
[4] Pisters R,Lane D A,Nieuwlaat R,et al.A novel user-friengly score(HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation:the Euro Heart Survey[J].Chest,2010,138(5):1093-1100.
[5] 唐莲,李晓英,赵富丽.华法林导致多次消化道出血1例[J].中国药物警戒，2014，11（6）：377-378.
[6] Levine G N，Bates E R，Blankenship J C，et al. 2011ACCF/AHA/
SCAI guideline for percutaneous comnary intervention：executive summary：are port of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guide lines and the Society for Cardiovascular Angiography and Interven-tions[J].Circulation，201l，124（23）：2574-2609.
[7] 万征，党群. 药物洗脱支架置入后双联抗血小板疗程的研究进展[J].中国介入心脏病学杂志，2013，21（1）：55-58.
[8] Park S J，Park D W，Kim Y H，et al．Duration of dual antiplatelet therapy after implantation of drug-eluting stents[J].N Engl J Med，2010，362（15）：1374-1382.
[9] Valgimigli M，Campo G，Monti M，et al．Short-versus long-term duration of dual-antiplatelet therapy after coronary stenting：a randomized multicenter trial[J]. Circulation，2012，125（16）：2015-2026.
[10] 杨军录，邓铁锁,程功，等.冠心病合并房颤PCI术后抗凝的临床观察[J].陕西医学杂志，2014,43（8）：969-970.
[11] 顾欣，孙安修，张新江，等.服用华法林患者用药合理性、安全性和依从性评价[J].中国药物警戒，2016,13（12）:753-756.
[12] 黄智勇，金辉.华法林抗凝作用的影响因素研究进展[J].医学综述，2011，17（3）：449-451.
[13]中华医学会心血管病学分会.华法林抗凝治疗的中国专家共识[J].中华内科杂志，2013，52（1）：76.
[14] 赵金凤，阮志勇，徐燕，等.冠心病患者经皮冠状动脉介入术后应用抗凝、抗血小板作用药物分析[J].中国医院用药评价与分析，2015，15（12）:1654-1656.
[15] Einstein-PE Investigators, Büller H R, Prins M H, et al.Oral rivaroxaban for the treatment of symptomatic pulmonary embolism[J].N Engl J Med,2012,366(14):1287-1297.
[16] Maria Cristina Constantinescu. Dabigatran is as effective as Warfarin in the treatment of acute venous thromboembolism theRE-COVER study[J].Maedica(Buchar),2010,5(1):77-78.
[17] Oldgren J，Budaj A，Granger C B,et al. Dabigatran vs. placebo in patients with acute coronary syndromes on dual antiplatelet therapy: a randomized，doubleblind，phaseⅡ trial[J].Eur Heart J，2011，32(22):2781-2789.