Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review

HUANG Yongjia; DING Ling; ZENG Fang; LIU Jie; LI Jindou; LIU Yihui

doi:10.6039/j.issn.1001-0408.2023.02.18

您当前的位置：

首页 >

文章列表页 >

Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review

更新时间：2025-09-25

- Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review
- ZHONGGUO YAOFANG Vol. 34, Issue 2, Pages: 223-227(2023)
- 作者机构：
  
  1.重庆市江津区中心医院药学部，重庆　402260
  2.华中科技大学同济医学院附属协和医院药剂科，武汉　430022
  3.重庆市江津区中心医院胃肠外科，重庆　402260
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.02.18
  CLC： R969;R972
- Received：28 June 2022，
  
  Revised：2022-12-20，
  
  Published：30 January 2023
- 稿件说明：
移动端阅览
黄永佳,丁玲,曾芳,等.血小板减少的房颤伴动脉粥样硬化患者的抗栓治疗管理策略及文献分析[J].中国药房,2023,34(02):223-227.

HUANG Yongjia,DING Ling,ZENG Fang,et al.Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review[J].ZHONGGUO YAOFANG,2023,34(02):223-227.
黄永佳,丁玲,曾芳,等.血小板减少的房颤伴动脉粥样硬化患者的抗栓治疗管理策略及文献分析[J].中国药房,2023,34(02):223-227. DOI： 10.6039/j.issn.1001-0408.2023.02.18.

HUANG Yongjia,DING Ling,ZENG Fang,et al.Management strategy of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis and a literature review[J].ZHONGGUO YAOFANG,2023,34(02):223-227. DOI： 10.6039/j.issn.1001-0408.2023.02.18.

摘要

目的

为血小板减少的房颤伴动脉粥样硬化患者的抗栓治疗管理提供参考。

方法

临床药师参与1例血小板减少的房颤伴动脉粥样硬化患者的治疗过程，根据患者病史、实验室检查结果等分析血小板减少原因，同时参考相关指南评估患者的血栓-出血风险，协助临床医师为患者制定个体化抗栓治疗方案及药学监护计划；检索中国知网收集血小板减少相关抗栓治疗的文献并进行分析。

结果

该患者血小板减少考虑为原发性血小板减少症可能性大，其出血风险主要是年龄≥65岁、存在出血倾向以及合并使用抗栓药物。临床药师评估患者的血栓-出血风险后，建议临床医师予以全剂量贝米肝素钠注射液+盐酸决奈达隆片+琥珀酸美托洛尔缓释片；针对血小板减少，临床医师予以复方皂矾丸、咖啡酸片和升血小板胶囊，但用药后患者出现腹泻，临床药师建议停用升血小板胶囊，临床医师采纳建议。患者出院时，临床药师建议出院抗栓治疗方案为单用抗凝或择期抗凝，临床医师考虑该患者目前血小板减低、尿潜血（+）和大便隐血弱阳性，故选择择期抗凝治疗，并嘱出院带药为琥珀酸美托洛尔缓释片+阿托伐他汀钙片。文献分析结果显示，血栓栓塞患者血小板减少的原因主要包括肝素诱导性血小板减少症、免疫性血小板减少症等，经对症治疗后所有患者均好转。

结论

临床药师通过参与血小板减少的房颤伴动脉粥样硬化患者的抗栓治疗管理，有效控制了患者的病情，确保了患者用药安全、有效。

Abstract

OBJECTIVE

To provide reference for the management of antithrombotic therapy in thrombocytopenia patients with atrial fibrillation and atherosclerosis.

METHODS

The clinical pharmacist participated in the treatment of a thrombocytopenia patient with atrial fibrillation and atherosclerosis， and analyzed the causes of thrombocytopenia according to the patient’s medical history and laboratory examination results. At the same time， the risk of thrombosis-bleeding was evaluated according to the relevant guidelines， and the clinicians were assisted in formulating individual antithrombotic therapy plan and pharmaceutical care plan for the patient. The literature on antithrombotic therapy related to thrombocytopenia was collected and analyzed by retrieving CNKI.

RESULTS

Thrombocytopenia was considered as primary thrombocytopenia in this patient， and the main risk of bleeding was age ≥65 years old， bleeding tendency， and combined use of antithrombotic drugs. After the clinical pharmacist assessed the risk of thrombosis and bleeding， the clinician was recommended to give full dose of Bemiheparin sodium injection + Dronedarone hydrochloride tablets + Metoprolol succinate sustained-release tablets. In view of thrombocytopenia， the clinician gave Compound zaofan pill， Caffeic acid tablet and Sheng xuexiaoban capsule， but the patient developed diarrhea after the medication. The clinical pharmacist suggested stopping Sheng xuexiaoban capsule， and the clinician adopted the clinical pharmacist’s suggestion. When the patient was discharged from hospital， the clinical pharmacist suggested that the antithrombotic therapy plan for discharge was anticoagulation alone or selective anticoagulation. The clinician chose selective anticoagulation treatment considering that the patient’s current thrombocytopenia， urinary occult blood （+） and fecal occult blood were weakly positive， and ordered the patient to take Metoprolol succinate sustained-release tablets + Atorvastatin calcium tablets at discharge. Literature analysis showed that the causes of thrombocytopenia of patients with thromboembolism mainly included heparin induced-thrombocytopenia， immune thrombocytopenia， etc. All patients were improved after symptomatic treatment.

CONCLUSIONS

By participating in the management of antithrombotic therapy for the thrombocytopenia patient with atrial fibrillation and atherosclerosis， clinical pharmacists can help effectively control the patient’s condition and ensure the safety and effectiveness of drug use.

关键词

Keywords

references

LEADER A ， GUREVICH-SHAPIRO A ， SPECTRE G . Anticoagulant and antiplatelet treatment in cancer patients with thrombocytopenia [J ] . Thromb Res ， 2020 ， 191 （ Suppl 1 ）： S68 - S73 .

国家卫生健康委，教育部，财政部，等 . 关于加强医疗机构药事管理　促进合理用药的意见 [EB/OL ] . [ 2022-12-11 ] . http：//www.nhc.gov.cn/yzygj/s7659/202002/ea3b96d-1ac094c47a1fc39cf00f3960e.shtml http://www.nhc.gov.cn/yzygj/s7659/202002/ea3b96d-1ac094c47a1fc39cf00f3960e.shtml .

CHAN F W H ， WONG R S M ， LAU W H ， et al . Management of Chinese patients on warfarin therapy in two models of anticoagulation service： a prospective randomized trial [J ] . Br J Clin Pharmacol ， 2006 ， 62 （ 5 ）： 601 - 609 .

DAGER W E ， BRANCH J M ， KING J H ， et al . Optimization of inpatient warfarin therapy：impact of daily consultation by a pharmacist-managed anticoagulation service [J ] . Ann Pharmacother ， 2000 ， 34 （ 5 ）： 567 - 572 .

DANIELS P R ， MANNING D M ， MORIARTY J P ， et al . Improving inpatient warfarin therapy safety using a pharmacist-managed protocol [J ] . BMJ Open Qual ， 2018 ， 7 （ 2 ）： e000290 .

LIP G Y H ， BANERJEE A ， BORIANI G ， et al . Antithrombotic therapy for atrial fibrillation：chest guideline and expert panel report [J ] . Chest ， 2018 ， 154 （ 5 ）： 1121 - 1201 .

LEE E J ， LEE A I . Thrombocytopenia [J ] . Prim Care ， 2016 ， 43 （ 4 ）： 543 - 557 .

STASI R ， AMADORI S ， OSBORN J ， et al . Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia [J ] . PLoS Med ， 2006 ， 3 （ 3 ）： e24 .

NEUNERT C ， LIM W ， CROWTHER M ， et al . The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia [J ] . Blood ， 2011 ， 117 （ 16 ）： 4190 - 4207 .

LU S S ， SHE M H ， ZENG Q ， et al . Sphingosine 1-pho-sphate and its receptors in ischemia [J ] . Clin Chim Acta ， 2021 ， 521 ： 25 - 33 .

CHEN P H ， CHEN X Y ， HE X L . Platelet-derived growth factors and their receptors：structural and functional perspectives [J ] . Biochim Biophys Acta ， 2013 ， 1834 （ 10 ）： 2176 - 2186 .

COLLET J P ， THIELE H ， BARBATO E ， et al . 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [J ] . Eur Heart J ， 2021 ， 42 （ 14 ）： 1289 - 1367 .

HINDRICKS G ， POTPARA T ， DAGRES N ， et al . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery（EACTS）：the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology（ESC）developed with the special contribution of the European Heart Rhythm Association（EHRA）of the ESC [J ] . Eur Heart J ， 2021 ， 42 （ 5 ）： 373 - 498 .

KEARON C ， AKL E A ， ORNELAS J ， et al . Antithrombotic therapy for VTE disease：chest guideline and expert panel report [J ] . Chest ， 2016 ， 149 （ 2 ）： 315 - 352 .

中国医师协会心血管内科医师分会血栓防治专业委员会，中华医学会心血管病学分会冠心病与动脉粥样硬化学组，中华心血管病杂志编辑委员会 . 急性冠状动脉综合征非血运重建患者抗血小板治疗中国专家共识：2018 [J ] . 中华心血管病杂志， 2019 ， 47 （ 6 ）： 430 - 442 .

JANION-SADOWSKA A ， PAPUGA-SZELA E ， ŁUKASZUK R ， et al . Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and thrombocytopenia [J ] . J Cardiovasc Pharmacol ， 2018 ， 72 （ 3 ）： 153 - 160 .

KIVINIEMI T ， KARJALAINEN P ， RUBBOLI A ， et al . Thrombocytopenia in patients with atrial fibrillation on oral anticoagulation undergoing percutaneous coronary intervention [J ] . Am J Cardiol ， 2013 ， 112 （ 4 ）： 493 - 498 .

LIVNEH N ， BRAEKEN D ， DROZDINSKY G ， et al . Anticoagulation in patients with atrial fibrillation，thrombocytopenia and hematological malignancy [J ] . J Thromb Thrombolysis ， 2021 ， 52 （ 2 ）： 590 - 596 .

陈智勇，闫小响 . 替罗非班引起的血小板减少症相关分析 [J ] . 中国动脉硬化杂志， 2022 ， 30 （ 7 ）： 633 - 639 .

邹玉彬，谢建新，路磊，等 . 多发伤预防性抗凝致肝素诱导血小板减少症1例 [J ] . 临床骨科杂志， 2022 ， 25 （ 2 ）： 241 .

闫姝洁，李景文，杨静，等 . 比伐卢定用于肝素诱导血小板减少症的体外循环心脏手术患者1例报告 [J ] . 中国体外循环杂志， 2022 ， 20 （ 1 ）： 35 - 37 .

刘宏明，王建，丁政 . 达肝素钠引起血小板减少合并动脉血栓形成 [J ] . 药物不良反应杂志， 2022 ， 24 （ 1 ）： 44 - 46 .

高小东，李奭慧，商子傲，等 . 妊娠合并肺栓塞及血小板减少1例 [J ] . 中华心血管病杂志， 2022 ， 50 （ 1 ）： 68 - 71 .

康世威，孙佳伟，宫小薇，等 . 以肺血栓栓塞症为首发表现的再生障碍性贫血诊断及治疗策略一例报道 [J ] . 实用心脑肺血管病杂志， 2022 ， 30 （ 1 ）： 128 - 131 .

蔡春花，林少娜，蔡秀梅，等 . 肝癌术后弥散性血管内凝血患者的抗凝治疗1例 [J ] . 汕头大学医学院学报， 2022 ， 35 （ 1 ）： 50 - 51，55 .

谢雯丽，王莉莉，曲鹏，等 . 血小板减少症伴发急性下壁心肌梗死并文献复习1例 [J ] . 中国临床研究， 2022 ， 35 （ 4 ）： 546 - 548，551 .

陈文浩，张妍，夏书月，等 . 急性肺血栓栓塞症合并血小板减少1例 [J ] . 沈阳医学院学报， 2022 ， 24 （ 2 ）： 157 - 160 .

Views

243

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Pharmaceutical care for the HIV-negative patient with disseminated Talaromyces marneffei osteomyelitis complicated by pulmonary tuberculosis

Expert consensus on rational medication management of targeted PI3K/Akt/mTOR inhibitors in breast cancer

Individualized treatment and pharmaceutical care for breast cancer complicated with chronic kidney disease

Pharmaceutical care of anti-infective treatment for a case of pulmonary infection due to Alternaria alternata after renal transplantation

Anticoagulation therapy analysis and pharmaceutical care for a breast cancer patient with pulmonary thromboembolism accompanied by multiple comorbidities

Related Author

ZHANG Qinghua

HE Liting

Writing Group of Expert Consensus on Rational Medication Management of Targeted PI3K/Akt/mTOR Inhibitors in Breast Cancer

任天舒

赵庆春

ZHANG Ming

YU Lu

WU Xudong

Related Institution

Dept. of Pharmacy， Jiangmen Central Hospital

Dept. of Internal Medicine， Zhonggongmiao Community Hospital of Ningbo Yinzhou District No.2 Hospital Medical Community

Dept. of Clinical Pharmacy， Ningbo Yinzhou District No.2 Hospital

Dept. of Pharmacy， Tangshan Maternal and Child Health Hospital

Dept. of Pharmacy， Tianjin Anding Hospital

⁰