【摘要】 目的:提高临床医师对心脏人工机械瓣膜置换术后华法林抗凝用药规范的认识。方法:检索已有的华法林抗凝治疗循证医学文献,以此评价一名7个月先天性心脏病患儿换瓣术后,住院期间低分子量肝素、华法林和维生素K1的应用过程。结果:术后第1~4天国际标准化比值(international normalized ratio,INR)均在正常参考值范围内。术后第6天INR达抗凝目标值,静脉滴注维生素K12 mg后,INR降到正常参考值。结论:临床医师对华法林抗凝过度的误判以及应用维生素K1处置不妥,且该病例可能存在华法林抵抗现象,说明了制定华法林抗凝治疗用药规范的重要性及开展相应临床药学工作的必要性。更多还原

【Abstract】 Objective: To enhance the understanding of guidelines for anticoagulant therapy with warfarin after mechanical valve replacement.Methods: We retrieved the evidence-based medicine literature of anticoagulant therapy with warfarin,so as to evaluate the management of a 7-month-old patient with congenital heart disease cured by low molecular weight heparin(LMWH),warfarin and vitamin K1 after mechanical valve replacement during in hospital.Results: The international normalized ratio(INR) of the patient was in the reference values from the first to fourth day after operation.The INR reached the target of anticoagulation at the sixth day after operation.Vitamin K1(2 mg) was given by intravenously guttae,then the INR dropped to the reference values.Conclusion: Clinical doctors have misjudged the over-anticoagulation of the warfarin and incorrectly used the vitamin K1.Warfarin resistance may have existed in this case.So it is necessary to carry out clinical pharmacy practice and is important to carry out standard of anticoagulant therapy with warfarin.更多还原