Antithrombotic therapy and pharmaceutical care of a child with purpura nephritis complicated with lower extremity deep venous thrombosis

LIU Weiting; LI Boxia; CHANG Yaowen

doi:10.6039/j.issn.1001-0408.2024.20.18

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Antithrombotic therapy and pharmaceutical care of a child with purpura nephritis complicated with lower extremity deep venous thrombosis

更新时间：2025-09-25

- Antithrombotic therapy and pharmaceutical care of a child with purpura nephritis complicated with lower extremity deep venous thrombosis
- ZHONGGUO YAOFANG Vol. 35, Issue 20, Pages: 2548-2551(2024)
- 作者机构：
  
  1.兰州大学第一医院药剂科，兰州　730013
  2.兰州市第一人民医院药剂科，兰州　730050
  3.兰州大学第一医院介入医学科，兰州　730013
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.20.18
  CLC： R969
- Received：13 June 2024，
  
  Revised：2024-09-24，
  
  Accepted：24 September 2024，
  
  Published：30 October 2024
- 稿件说明：
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刘维婷,李波霞,常耀文.1例紫癜性肾炎合并下肢深静脉血栓形成患儿的抗栓治疗分析与药学监护[J].中国药房,2024,35(20):2548-2551.

LIU Weiting,LI Boxia,CHANG Yaowen.Antithrombotic therapy and pharmaceutical care of a child with purpura nephritis complicated with lower extremity deep venous thrombosis[J].ZHONGGUO YAOFANG,2024,35(20):2548-2551.
刘维婷,李波霞,常耀文.1例紫癜性肾炎合并下肢深静脉血栓形成患儿的抗栓治疗分析与药学监护[J].中国药房,2024,35(20):2548-2551. DOI： 10.6039/j.issn.1001-0408.2024.20.18.

LIU Weiting,LI Boxia,CHANG Yaowen.Antithrombotic therapy and pharmaceutical care of a child with purpura nephritis complicated with lower extremity deep venous thrombosis[J].ZHONGGUO YAOFANG,2024,35(20):2548-2551. DOI： 10.6039/j.issn.1001-0408.2024.20.18.

摘要

目的

为下肢深静脉血栓形成（DVT）患儿抗栓治疗方案的制定提供参考。

方法

临床药师参与1例紫癜性肾炎合并下肢DVT患儿的抗栓治疗过程，为患儿制定个体化给药方案。考虑患儿下肢DVT经抗凝治疗后未缓解再次入院，临床药师与临床医师联合会诊后建议继续使用依诺肝素钠注射液30 mg，q12 h，皮下注射，抗凝治疗，同时行置管溶栓治疗和溶栓药物治疗（静脉泵入注射用尿激酶20万单位，qd）；关注患儿不良反应发生情况，监测凝血指标变化；对于出院后的长期抗凝治疗，建议口服利伐沙班片10 mg，qd，并根据患儿体重变化调整药物剂量。

结果

临床医师采纳建议。患儿经治疗后凝血指标恢复正常，下肢DVT症状明显好转，且出院后未出现出血及其他血栓事件。

结论

临床药师依据药学专业知识协助临床医师为患儿制定个体化的抗栓治疗方案，有助于保障儿童用药的有效性和安全性。

Abstract

OBJECTIVE

To provide a reference for the formulation of the antithrombotic treatment regimen of children with lower extremity deep venous thrombosis （DVT）.

METHODS

The clinical pharmacist participated in the antithrombotic treatment of a child with purpura nephritis complicated with lower extremity DVT and formulated an individualized dosing plan for the child. Considering that the child was readmitted to the hospital when DVT of the lower extremities did not relieve after anticoagulation therapy， it was recommended that thrombolytic therapy （Enoxaparin sodium injection 30 mg， q2 h， i.d.） be initiated after joint consultation by clinical pharmacists and physicians； catheter thrombolysis and thrombolytic drug therapy were simultaneously performed （intravenous infusion of 200 000 units of Urokinase for injection， per day）； great attention should be paid to the occurrence of adverse drug reactions in children， and the changes in coagulation indexes of the children should be monitored. For long-term anticoagulation therapy after discharge， clinical pharmacists recommended oral Rivaroxaban tablets 10 mg， qd， and adjusted the dose according to the weight change of the child.

RESULTS

The clinician adopted the pharmacist’s recommendations. After drug thrombolytic therapy， the child’s coagulation indicators returned to normal， the symptoms of lower extremity DVT improved significantly， and there were no adverse events of bleeding or other thrombotic events after discharge.

CONCLUSIONS

Clinical pharmacists can assist clinicians in formulating individualized treatment plans for children based on their expertise in pharmacy to ensure the rationality of medication use in children， which helps ensure the effectiveness and safety of medication for children.

关键词

Keywords

references

KAKKOS S K ， GOHEL M ， BAEKGAARD N ， et al . Editor’s choice-European Society for Vascular Surgery（ESVS）2021 clinical practice guidelines on the management of venous thrombosis [J ] . Eur J Vasc Endovasc Surg ， 2021 ， 61 （ 1 ）： 9 - 82 .

MAHAJERIN A ， BRANCHFORD B R ， AMANKWAH E K ， et al . Hospital-associated venous thromboembolism in pediatrics：a systematic review and meta-analysis of risk factors and risk-assessment models [J ] . Haematologica ， 2015 ， 100 （ 8 ）： 1045 - 1050 .

TAKEMOTO C M ， SOHI S ， DESAI K ， et al . Hospital-associated venous thromboembolism in children：incidence and clinical characteristics [J ] . J Pediatr ， 2014 ， 164 （ 2 ）： 332 - 338 .

LI W J ， SHA M ， MA W ， et al . Efficacy evaluation of D-dimer and modified criteria in overt and nonovert disseminated intravascular coagulation diagnosis [J ] . Int J Lab Hematol ， 2016 ， 38 （ 2 ）： 151 - 159 .

WALLER A P ， TROOST J P ， PARIKH S V ， et al . Nephrotic syndrome disease activity is proportional to its associated hypercoagulopathy [J ] . Thromb Res ， 2021 ， 201 ： 50 - 59 .

王辉，梁颖 . 儿童肾病综合征并发血栓栓塞的诊断和治疗 [J ] . 中国小儿急救医学， 2021 ， 28 （ 7 ）： 552 - 556 .

WANG H ， LIANG Y . The diagnosis and treatment of thromboembolism in children with nephrotic syndrome [J ] . Chin Pediatr Emerg Med ， 2021 ， 28 （ 7 ）： 552 - 556 .

MONAGLE P ， CUELLO C A ， AUGUSTINE C ， et al . American Society of Hematology 2018 guidelines for management of venous thromboembolism：treatment of pediatric venous thromboembolism [J ] . Blood Adv ， 2018 ， 2 （ 22 ）： 3292 - 3316 .

WOODS G M ， KIM D W ， PADEN M L ， et al . Thrombolysis in children：a case report and review of the literature [J ] . Front Pediatr ， 2021 ， 9 ： 814033 .

四川省医学科学院·四川省人民医院，电子科技大学医学院，个体化药物治疗四川省重点实验室，等 . 儿童血栓性疾病防治药学实践指南 [J ] . 医药导报， 2024 ， 43 （ 7 ）： 1017 - 1038 .

Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital ， School of Medicine ， University of Electronic Science and Technology of China ， Personalized Drug Therapy Key Laboratory of Sichuan Province ， et al . Pharmacy practice guidelines for the prevention and treatment of thromboembolic diseases in children [J ] . Her Med ， 2024 ， 43 （ 7 ）： 1017 - 1038 .

GABALLAH M ， SHI J Z ， KUKREJA K ， et al . Endovascular thrombolysis in the management of iliofemoral thrombosis in children：a multi-institutional experience [J ] . J Vasc Interv Radiol ， 2016 ， 27 （ 4 ）： 524 - 530 .

LLERENA L D ， CÁCERES-LÓRIGA F M ， BETANCOURT B Y . Recombinant streptokinase：evidences from clinical use [J ] . Eur Heart J ， 2005 ， 26 （ 14 ）： 1448 - 1449 .

GRUNWALD M R ， HOFMANN L V . Comparison of urokinase，alteplase，and reteplase for catheter-directed thrombolysis of deep venous thrombosis [J ] . J Vasc Interv Radiol ， 2004 ， 15 （ 4 ）： 347 - 352 .

中华医学会外科学分会血管外科学组 . 深静脉血栓形成的诊断和治疗指南：第三版 [J ] . 中华普通外科杂志， 2017 ， 32 （ 9 ）： 807 - 812 .

Vascular Surgery Group of the Surgery Branch of the Chinese Medical Association . Guidelines for diagnosis and treatment of deep venous thrombosis：third edition [J ] . Chin J Gen Surg ， 2017 ， 32 （ 9 ）： 807 - 812 .

李晓强，王深明 . 深静脉血栓形成的诊断和治疗指南：第2版 [J/OL ] . 中国医学前沿杂志（电子版）， 2013 ， 5 （ 3 ）： 53 - 57 [ 2024-05-25 ] . https：//qikan.cqvip.com/Qikan/Article/ReadIndex?id=1002149362&info=JXkrC8DkNk0OCuCY-5Vc5bVx0kXQ2Zi01ynyI6jvY1BJmsgK62aoykg%3d%3d https://qikan.cqvip.com/Qikan/Article/ReadIndex?id=1002149362&info=JXkrC8DkNk0OCuCY-5Vc5bVx0kXQ2Zi01ynyI6jvY1BJmsgK62aoykg%3d%3d .

LI X Q ， WANG S M . Guidelines for diagnosis and treatment of deep venous thrombosis：2nd edition [J/OL ] . Chin J Front Med Sci Electron Version ， 2013 ， 5 （ 3 ）： 53 - 57 [ 2024-05-25 ] . https：//qikan.cqvip.com/Qikan/Article/ReadIndex?id=1002149362&info=JXkrC8DkNk0OCuCY-5Vc5bVx0kXQ2Zi01ynyI6jvY1BJmsgK62aoykg%3d%3d https://qikan.cqvip.com/Qikan/Article/ReadIndex?id=1002149362&info=JXkrC8DkNk0OCuCY-5Vc5bVx0kXQ2Zi01ynyI6jvY1BJmsgK62aoykg%3d%3d .

中华医学会儿科分会肾脏病学组 . 儿童常见肾脏疾病诊治循证指南：一：激素敏感、复发/依赖肾病综合征诊治循证指南：试行 [J ] . 中华儿科杂志， 2009 ， 47 （ 3 ）： 167 - 170 .

Nephrology Group of the Chinese Medical Association Pediatric Branch . Evidence-based guidelines on diagnosis and treatment of childhood common renal diseases：Ⅰ：evidence-based guideline on diagnosis and treatment of hormone-sensitive，recurrent/dependent nephrotic syndrome：for trial implementation [J ] . Chin J Pediatr ， 2009 ， 47 （ 3 ）： 167 - 170 .

LAPOSTOLLE F ， SIGURET V ， MARTIN A C ， et al . Vitamin K antagonists and emergencies [J ] . Eur J Emerg Med ， 2018 ， 25 （ 6 ）： 378 - 386 .

US Food and Drug Administration . FDA approves first oral blood thinning medication for children [EB/OL ] .（ 2021-06-21 ）[ 2024-05-25 ] . http：//www.fda.gov/news-events/press-announcements/fda-approves-first-oral-blood-thinning- medication-children http://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-blood-thinning-medication-children .

AJMAL M ， FRIEDMAN J ， SIPRA Q U A R ， et al . Rivaro-xaban：expanded role in cardiovascular disease management：a literature review [J ] . Cardiovasc Ther ， 2021 ， 2021 ： 8886210 .

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