Pharmaceutical care of antithrombotic therapy for heparin-induced thrombocytopenia after percutaneous coronary intervention

GUAN Wenjie; CHEN Huihui; WANG Tao; ZHANG Chenchen; CHEN Yanjie; ZHU Jie

doi:10.3969/j.issn.1006-0111.2019.04.017

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Objective To explore clinical pharmacists' role in antithrombotic therapy for acute myocardial infarction (AMI) inpatients with heparin-induced thrombocytopenia (HIT) after percutaneous coronary intervention (PCI). Methods Clinical pharmacists used the acute coronary syndrome clinical risk score (GRACE) and anti-platelet and anticoagulant treatment bleeding risk score (Crusade) to assess the risk of ischemia and bleeding in order to adjust the dose for antiplatelet therapy.The causes of thrombocytopenia and coagulation were evaluated.The possible medication related factors were identified for HIT patient.Argatroban was used to replace anticoagulant therapy and APTT was closely monitored in order to adjust dose in a timely manner.Warfarin was recommended for the discharged patients based on the mechanism of action,adverse reactions,safety and economics. Results No bleeding or thromboembolic complications was observed on the patient with argatroban for anticoagulant therapy and aspirin plus clopidogrel as maintenance therapy. Conclusion With good understanding in pharmacology and pharmacokinetics,clinical pharmacists can help doctors to solve the problems related to drug therapy in time.Therefore,better pharmaceutical care can be provided to patients with improved medication safety and rationality.

Pharmaceutical care of antithrombotic therapy for heparin-induced thrombocytopenia after percutaneous coronary intervention

Department of Pharmacy, Hospital 901 of the Joint Logistics Support Force of PLA, Hefei 230031, China

Received Date: 2019-03-01

Rev Recd Date: 2019-05-24

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Abstract: Objective To explore clinical pharmacists' role in antithrombotic therapy for acute myocardial infarction (AMI) inpatients with heparin-induced thrombocytopenia (HIT) after percutaneous coronary intervention (PCI). Methods Clinical pharmacists used the acute coronary syndrome clinical risk score (GRACE) and anti-platelet and anticoagulant treatment bleeding risk score (Crusade) to assess the risk of ischemia and bleeding in order to adjust the dose for antiplatelet therapy.The causes of thrombocytopenia and coagulation were evaluated.The possible medication related factors were identified for HIT patient.Argatroban was used to replace anticoagulant therapy and APTT was closely monitored in order to adjust dose in a timely manner.Warfarin was recommended for the discharged patients based on the mechanism of action,adverse reactions,safety and economics. Results No bleeding or thromboembolic complications was observed on the patient with argatroban for anticoagulant therapy and aspirin plus clopidogrel as maintenance therapy. Conclusion With good understanding in pharmacology and pharmacokinetics,clinical pharmacists can help doctors to solve the problems related to drug therapy in time.Therefore,better pharmaceutical care can be provided to patients with improved medication safety and rationality.

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Pharmaceutical care of antithrombotic therapy for heparin-induced thrombocytopenia after percutaneous coronary intervention

doi: 10.3969/j.issn.1006-0111.2019.04.017

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