【摘要】 目的 探讨血栓弹力图（TEG）对临床药师调整经皮冠脉介入术（PCI）术后急性期合并上消化道出血患者抗栓治疗方案的指导作用。方法 临床药师参与1例不稳定型心绞痛患者PCI术后急性期合并上消化道出血的治疗，通过TEG监测各项指标，调整抗栓药物治疗方案，并进行全程药学监护。结果 临床药师建议，双联抗血小板治疗6 d后，重启阿司匹林单抗治疗；停药10 d后，调整抗栓方案为阿司匹林肠溶片100 mg+硫氢酸氯吡格雷片75 mg，每天1次，口服。医师采纳建议，患者转归良好。结论 在患者出现致命性出血事件与抗栓治疗方案发生矛盾时，可应用TEG进行个体化精准抗栓治疗方案调整，为该类患者的救治提供循证依据。更多还原

【Abstract】 Objective To investigate the guiding role of thromboelastography(TEG) for clinical pharmacists in adjusting the anti-thrombotic therapy for a patient with acute upper gastrointestinal bleeding(UGIB) after percutaneous coronary intervention(PCI).Methods A clinical pharmacist participated in the treatment of a patient with unstable angina pectoris complicated with UGIB in the acute phase after PCI. The various indicators were monitored by the TEG,the treatment plan of anti-thrombotic drugs was adjusted,and full pharmaceutical care for the patient was provided.Results dual antiplatelet therapy,aspirin monoclonal antibody therapy should be restarted. After 10 d of drug withdrawal,the anti-thrombotic therapy was adjusted to oral administration of Aspirin Enteric-Coated Tablets(100 mg)+ Clopidogrel Sulfate Tablets(75 mg),once a day. The physician adopted the clinical pharmacist’s suggestion,and the patient’s prognosis was good.Conclusion When there is a conflict between fatal bleeding events and anti-thrombotic therapy in the patient,TEG can be used for individualized and precise adjustment of anti-thrombotic therapy,which can provide an evidence-based basis for the treatment of these patients.更多还原