谭红阳+++++万建伟

    [摘要] 临床药师通过对1例静脉血栓栓塞症(VTE)患者进行连续性药学监护，对患者抗凝治疗的安全性、有效性起到积极作用。患者住院期间，临床药师参与制订初始治疗方案并进行药学监护；通过对抗凝效果和患者用药情况，协助医师为患者制订了个体化给药方案，并对患者进行用药教育。待患者病情稳定出院后，临床药师对其进行跟踪随访，根据患者后续情况协助医师再次调整用药方案，使患者国际标准化测量值达标并维持稳定。

    [关键词] 静脉血栓栓塞症；抗凝治疗；药学服务；连续性

    [中图分类号] R543 [文献标识码] A [文章编号] 1673-7210(2017)10(c)-0157-04

    Effect of continuous pharmaceutical care on anticoagulation in a patient with VTE

    TAN Hongyang1 WAN Jianwei2

    1.Department of Pharmacy， Pudong Center for Mental Health， Shanghai 200124， China； 2.Department of Pharmacy， Zhoupu Hospital of Shanghai Pudong New District， Shanghai 201318， China

    [Abstract] Clinical pharmacists played active roles in the safety and effectiveness of anticoagulant therapy in a patient with VTE， by means of continuous pharmaceutical care. When the patient was hospitalized， clinical pharmacists participated in the formulation of initial therapeutic schedule and carried out pharmaceutical care. Then clinical pharmacists assisted physicians to develop individualized drug regimen， according to the anticoagulant effect and patient′s medication situation. After the patient was stable and discharged ......