张强 潘一滨 叶孙送

    [摘要] 临床过程中遇到1例特殊患者，为心脏瓣膜置换术后，需要长期服用华法林抗凝，同时患有缺铁性贫血及高血压病。入院后，拟行手术治疗，为完善治疗，请临床药师及内科医师参与制订围术期抗凝策略及内科疾病治疗计划。患者手术顺利，术中无明显出血，术后无血栓栓塞及明显出血情况发生，血压平稳。术后1周内患者顺利出院，随访至术后9个月，患者病情稳定，未出现出血症状。因病例特殊，故予以分享，同时就临床医师较为关注的抗凝问题进行重点文献回顾分析及讨论。

    [关键词] 华法林；围术期；桥接；肝素；抗凝药；便血；混合痔

    [中图分类号] R969.3 [文献标识码] A [文章编号] 1673-7210(2017)05(c)-0167-03

    [Abstract] Clinical pharmacists and clinicians help to analyze and develop practical strategy for 1 case of patient with iron deficiency anemia and high blood pressure， and with long-term oral taking history of Warfarin after heart valve replacement surgery. During the process of operation， no obvious bleeding happened， no thromboembolism and bleeding occured， and high blood pressure is stable after operation. Patient has discharged within a week， followed up to 9 months， the patient is in stable condition and has no hemorrhage symptom. According to review of the literatures， the choice of Warfarin in perioperative period is analyzed.

    [Key words] Warfarin； Perioperative period； Bridge； Heparin； Anticoagulant； Hematochezia； Mixed hemorrhoids ......