华法林致深静脉血栓合并急性肾功能不全患者中毒性表皮坏死 松解症的药学监护

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中图分类号R969.3 文献标志码A 文章编号 1001-0408（2025）18-2317-05

DOI 10.6039/j.issn.1001-0408.2025.18.18

Pharmaceutical care for toxic epidermal necrolysis in patients with deep vein thrombosis and acute renal insufficiency induced by warfarin

SHI Chao，SHU Dezhong（Dept.of Pharmacy，Fuling Hospital Afiliated to Chongqing University，Chongqing 408000，China）

ABSTRACTOBJECTIVEToprovideareference forpharmaceutical careof patients with deepveinthrombosisandacute renal insuffciencythatdeveloptoxicepidermal necrolysis（TEN）aftertakingwarfarininclinicalpractice.METHODSClinical pharmacistsparticipatedinthepharmaceuticalcareforapatientwithdepveinthrombosisandacuterenalinsufficiencythat developedTENaftertakingwarfarin.BasedontheNaranjo’saessmentscaleandthecausalityjudgmentcriteriaoftheNational CenterforAdverseDrugReactionMonitoring，theclinicalpharmacistsdeterminedthattheassociationbetweenTENandwarfarin was“probable".The TENscore（SCORTEN）was3.Regarding theTEN that ocurred in the patient，the clinical pharmacists recommendeddiscontinuingwarfarin，strengtheninganti-alergictreatment，requestingasistancefromtheburnand plasticsurgery departmentfordiagnosisandtreatment，and strengthening monitoring.When thepatient’srenalfunctiongraduallyrecovered，it wasrecommendedtoreplaceheparinwithrivaroxaban.Aftertheinfectionwascontroled，theanti-infectivedrugwithdrawalwas sugested.RESULTSThephysicianadoptedtheclinicalpharmacist’ssuggestions.Thepatientimprovedafertreatment，was allowed tobedischarged with medication，andno similarreactions recurred during folow-upafter discharge.CONCLUSIONS The occurrenceofTENcausedbywarfarin inpatientswithdeeveinthrombosisandacuterenalinsuffciencyisrelativelyrare.The mechanimisucear.Duringcliicalaplication，itisessarytostrengthenmonitoringofbloodroutine，coagulatioprofile， renalfunctionandinflammatoryindicators.IfTENissuspected，thedrugshouldbeimmediatelyiscontinued，andsptomatic treatment，suchasantiallergic treatmentshouldbegiven.Communicationofclinical pharmacistswiththephysiciansshouldbe strengtheed，patient folow-up should beimproved，and thedrug treatment plan shouldbeoptimized toensure thesafetyof the patient's medication.

KEYWORDS warfarin； toxic epidermal necrolysis； deepveinthrombosis；adverse drug reactions；clinical pharmacist

深静脉血栓是指血液在深静脉异常凝结形成的血栓，多见于下肢（如股静脉、胭静脉），可导致肺栓塞等严重并发症，早期进行抗凝可防治血栓蔓延，降低肺栓塞发生风险和患者死亡率。（剩余8999字）