A Clinical pharmacist was fully involved in the anticoagulation drug treatment management process of a 104-year-old patient with a large area of cerebral infarction combined with chronic kidney disease stage V and secondary deep vein thrombosis. After the patient was diagnosed with deep vein thrombosis, the clinical pharmacist comprehensively analyzed the patient's super-advanced age, history of atrial fibrillation, large area of cerebral infarction, extremely poor kidney function, deep vein thrombosis, and high bleeding risk indicated by the HAS-BLED score. They worked with the clinical doctor to develop an individualized anticoagulation treatment strategy for the patient. At the beginning of the treatment, warfarin was given to the patient at a daily dose of 1.25 mg, and the patient's coagulation indicators and kidney function were dynamically rechecked. The patient's blood creatinine level did not show significant changes throughout the anticoagulation treatment process. On the 8th day of medication, the patient's INR was 2.47, and the clinical pharmacist suggested adjusting the Warfarin to an alternate-day dose of 1.25 mg and 0.625 mg. Subsequently, the patient's INR was 2.41, and the condition improved, leading to discharge. Throughout the anticoagulation drug management process, the clinical pharmacist participated in the clinical decision-making for anticoagulant drug selection,provided professional medication guidance, and pharmacological monitoring to ensure the safe clinical use of drugs for special populations.

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