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目的探讨临床药师参与1例晚期肺癌患者因厄洛替尼与华法林相互作用导致皮下血肿治疗的作用。方法 1例晚期肺癌合并静脉血栓栓塞症患者在厄洛替尼和华法林治疗期间,出现国际标准化比值(INR)升高伴皮下血肿。临床药师在患者入院后通过详细问诊患者口服厄洛替尼治疗后药物不良反应及同服食物和药物情况,分析两者代谢特点及相互作用机制。结果与结论临床药师认为厄洛替尼所导致的腹泻以及其与华法林潜在药物相互作用导致了华法林药效的增强,引起了INR升高以及出血事件的发生。综合其华法林相关基因检测结果,建议降低华法林剂量至1.5 mg,qd,并密切监测INR。临床药师在肿瘤治疗中发挥药学专长,监护用药安全的价值与作用。
Objective To investigate the role of clinical pharmacists in the treatment of subcutaneous hematoma caused by the interaction of erlotinib and warfarin in one patient with advanced lung cancer. Methods One patient with advanced lung cancer complicated with venous thromboembolism presented with elevated international normalized ratio (INR) with subcutaneous hematoma during the course of treatment with erlotinib and warfarin. The clinical pharmacist analyzed the metabolic characteristics and the interaction mechanism of the two drugs by analyzing the adverse drug reactions and oral administration of erlotinib after oral administration of erlotinib. RESULTS AND CONCLUSION: The clinical pharmacists believe that erlotinib-induced diarrhea and its potential drug interaction with warfarin lead to enhanced efficacy of warfarin, resulting in increased INR and bleeding events. Combined with its warfarin-related gene test results, it is recommended to reduce the warfarin dose to 1.5 mg, qd, and close monitoring of INR. Clinical pharmacists play a pharmaceutical expertise in cancer treatment, monitoring the value and role of drug safety.