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Objective To explore the efficacy and safety of dabigatran etexilate in the treatment of elderly patients with non-valvular atrial fibrillation (NVAF), so as to provide reference for clinical treatment and rational drug use. Methods Eighty elderly patients with NVAF in The Seventh People's Hospital of Shanghai from December 2020 to June 2021, aged 65 to 80 years, were enrolled in a self-controlled study. Dabigatran etexilate 110 mg was given orally, twice a day (one in the morning and one in the evening) for 6 months. During the follow-up visit, the coagulation function indexes including APTT, TT, FIB and D-D were observed in patients taking medicine for 1 month and 6 months. Liver function indexes including ALT, AST and TBIL, renal function indicators including UREA and eGFR, and blood routine indexes including HGB and ESR, also were observed in patients taking medicine for 1 month and 6 months. Results Patients were compared at 1 month and 6 months after treatment with dabigatran and before: the difference of coagulation function indexes as APTT and TT was statistically significant (P<0.05);There was no significant difference in liver function index, renal function index and blood routine index (P>0.05); A total of 25 adverse events occurred, and the incidence rate of adverse reactions was 31.25%, there was no adverse events such as serious hemorrhage，life threatening and organ failure hemorrhage occurred．Conclusion Dabigatran has good efficacy and safety in the treatment of the elderly NVAF.
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Objective To explore the strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation.
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OBJECTIVE:To evaluate the feasibility of using CYP2C19 gene to guide the use of antiplatelet agents in acute cor-onary syndrome(ACS)patients undergoing interventional operation in China from the viewpoint of pharmacoeconomics. METH-ODS:Based on global PLATO trial data,the patients were divided into 3 groups according to treatment strategies(clopidogrel group,ticagrelor group,genetic test group). By applying Treeage Pro 2011 software,short-term decision tree model and long-term Markov model were established,and related data were imported to evaluate cost-effectiveness of different treatment strategies. RE-SULTS&CONCLUSIONS:For ACS patients,according to the level of GDP in China,conventional use of ticagrelor is of pharma-coeconomic advantage for in Shanghai and uninsured patients insured patients;the use of antiplatelet agents guided by CYP2C19 gene test is of pharmacoeconomic advantage among nationwide insured patients.
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Objective To explore the role of clinical pharmacists in analyzing and dealing with abnormal INR value fluc-tuations caused by the drug interaction of warfarin and amiodarone in a post heart valve replacement patient .Methods By com-paring interactions between warfarin and other drugs ,we investigated the drugs the patient was using ,found the cause of unu-sual INR value fluctuations ,and regulated warfarin dosage in time .After that ,we intensified the monitoring of coagulation function and offered detailed pharmaceutical care to the patient .In addition ,we studied the possible reasons for the phenome-non from the following aspects such as the drug action mechanisms of warfarin and amiodarone ;the interaction mechanisms of the two drugs ;the correlation of anticoagulation effects of warfarin ,the dosage and concentration of combined use of these two drugs .Results The reason for unusal INR value fluctuations was identified as the drug interaction between warfarin and amio-darone .Amiodarone can enhance the anticoagulant effects of warfarin ,increase the risk of bleeding .By stoping warfarin for 3 days ,INR value was restored to the target range .Then we continued the anticoagulant therapy ,and the condition of the pa-tient was controlled steadily ,and he was discharged smoothly .Conclusion Clinical pharmacists can help doctors find out prob-lems related to drug therapy in time by providing effective pharmaceutical care to patients ,so doctors may adjust the treatment in time .When using the drugs interacted with warfarin ,we have to consider the those drug effects on anticoagulant therapy .In order to adjust regimens in time ,we must understand the pharmacology and pharmacokinetics of the drugs we used at the same time;as well ,we must intensify monitoring .Therefore ,we can improve the safety and rationality of clinical medication ,and also can provide better pharmaceutical care for patients .