傅芳 陈聪琴 肖洁 刘弋戈

    摘 要 目的：探讨肾功能不全合并特殊药物基因型复杂房颤患者抗凝治疗个体化给药策略。方法：临床药师参与1例肥厚型心肌病合并房颤患者的抗凝治疗实践，根据患者病理生理变化，结合药物基因检测结果，优化抗凝治疗方案，为临床提供合理用药建议。结果：根据患者肾功能变化情况，调整抗凝药物，根据基因型检测结果调整华法林给药剂量，保障用药安全。结论：临床药师参与患者治疗，发挥专业特长，提供合理用药建议，保证抗凝治疗的有效性和安全性。

    关键词 直接口服抗凝药 华法林 基因型 个体化给药 房颤

    中图分类号：R969.3； R973.2 文献标志码：B 文章编号：1006-1533(2021)13-0063-04

    Clinical pharmacists participate in the practice of anticoagulant therapy for a patient with hypertrophic cardiomyopathy complicated by atrial fibrillation

    FU Fang， CHEN Congqin， XIAO Jie， LIU Yige

    (Department of Pharmacy， Xiamen Cardiovascular Hospital， Xiamen 361006， China)

    ABSTRACT Objective： To explore the treatment strategy of the individualized administration of anticoagulant drug in a complicated atrial fibrillation patient with renal impairment and special drug genotype. Methods： The clinical pharmacists participated in the practice of anticoagulant therapy for a patient with hypertrophic cardiomyopathy complicated by atrial fibrillation ......