1例冠状动脉旁路移植术后新发心房颤动患者的 抗栓治疗与药学监护

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【中图分类号】R97 【文献标识码】A

【Abstract】 The 69-year-old male patient developed new-onset atrial fibrillation （AF） 2 days after coronary artery bypass grafting （CABG），and it recurred 2 days later. The clinical pharmacist reviewed domestic and international literature， taking into account the patient's medical history，age，and symptoms，and after assessing the risks of thrombosis and bleeding，recommended a triple antithrombotic therapy with rivaroxaban，aspirin，and ticagrelor， which the physician accepted. During hospitalization，the patient maintained sinus rhythm （70-100 beats/min） without bleding complications.When the patient was discharged， considering that prolonged triple antithrombotic therapy could increase the risk of bleeding and that related coagulation parameters could not be monitored outside the hospital， the clinical pharmacist recommended discontinuing ticagrelor and continuing antithrombotic therapy with aspirin and rivaroxaban. The patient was instructed to follow up one month after surgery for re-evaluation and adjustment of the antithrombotic treatment， which was adopted by the physician.Clinical pharmacists asisted physicians in developing individualized antithrombotic treatment plans for patientsand provided pharmaceutical care to the patients' treatment proces，which efectively controled thecondition and ensured that the patients' medication was safe and effective.This case could provide a reference for the management of antithrombotic therapy in patients with new-onset AF after CABG.

【Keywords】Atrial fibrillation; Coronary artery bypass grafting; Antithrombotic therapy Pharmaceutical care

术后心房颤动（postoperative atrial fibrillation，POAF）是一种常见的继发性心房颤动（atrialfibrillation，AF）。（剩余13081字）