心脏机械瓣膜患者行脑血管介入术围手术期抗栓治疗的药学服务OA

Objective To explore the perioperative antithrombotic therapy strategies and the connotation of pharmaceu-tical care for patients undergoing cerebrovascular stent implantation after mechanical heart valve replacement.Methods Clini-cal pharmacists participated in the perioperative antithrombotic treatment process of a patient who underwent cerebrovascular stent implantation after cardiac valve replacement,assisted physicians in formulating and optimizing the perioperative antithrombotic therapy plan,and provided the patient with full-course pharmaceutical care.Results The patient did not experience thrombo-embolic or bleeding events during hospitalization and was discharged after recovery.The discharge antithrombotic regimen was as-pirin combined with warfarin for six months,followed by long-term anticoagulation with warfarin alone.The patient has remained stable after discharge,and the international normalized ratio(INR)has reached the target range.Conclusions The key to the perioperative antithrombotic therapy strategy for patients undergoing cerebrovascular interventional surgery after heart mechani-cal valve replacement lies in the assessment of thromboembolic risk and bleeding risk.Clinical pharmacists should establish a full-course pharmaceutical care model encompassing risk prediction,regimen optimization,pharmaceutical monitoring,patient educa-tion and follow-up,so as to give full play to their role in ensuring safe medication use.