Résumé
OBJECTIVE: To find out the essentials of clinical pharmacists' work on making individualized anticoagulation therapy, tailored to patients with deep vein thrombosis and pulmonary tuberculosis, and on its pharmaceutical care. METHODS: The clinical pharmacist participated in one case of individualized anticoagulation therapy and provided pharmaceutical care to one patient with deep vein thrombosis and pulmonary tuberculosis. The patient used to take warfarin, but the treatment was ineffective, therefore the clinical pharmacist tried to find out the reason from such aspects as interactions among genetic polymorphism, anticoagulants and anti-TB drugs, then adjusted the therapy for the patient. RESULTS: A dosage regimen suitable for the patient was formulated, and medication education was carried out to the patient in terms of medication instructions, such as influencing factors on curative effects of warfarin and monitoring of INR, to improve the patient compliance related to anticoagulation therapy. CONCLUSION: Clinical pharmacists should start pharmaceutical service right from making individualized anticoagulation therapy and carrying out pharmaceutical care.