Analysis of anticoagulant therapy and pharmaceutical care for a patient with obstetrical antiphospholipid syndrome complicated with HELLP syndrome

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Affiliation: 1. Department of Pharmacy, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China 2. School of Pharmacy, Nanjing Medical University, Nanjing 211166, China

Keywords: Obstetric antiphospholipid syndrome HELLP syndrome Anticoagulant therapy Pregnancy Lactation Pharmaceutical care

DOI: 10.12173/j.issn.1005-0698.202307054

Reference: ZHU Yue, HUANG Xiaona.Analysis of anticoagulant therapy and pharmaceutical care for a patient with obstetrical antiphospholipid syndrome complicated with HELLP syndrome[J].Yaowu Liuxingbingxue Zazhi,2024, 33(2):218-223.DOI: 10.12173/j.issn.1005-0698.202307054.[Article in Chinese]  Copied

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Abstract

A 37-year-old woman with obstetric antiphospholipid syndrome (OAPS) was admitted to hospital due to poorly controlled hypertensive. After admission, the patient's blood pressure fluctuated greatly (152-161/100-112mmHg), platelet count decreased progressively (65×10⁹·L^-1), with lactate dehydrogenase of 367 U·L^-1, alanine aminotransferase of 121.8 U·L^-1, and aspartate aminotransferase of 89 U·L^-1, and the disease progressed to HELLP syndrome. The clinical pharmacists participated in the treatment of this patient, combined the patient's risk of thrombosis and bleeding, changes in platelet count, and pharmacokinetic characteristics of anticoagulant drugs to assist clinicians in formulating the individualized anticoagulant treatment plan in the perinatal period, and promptly stopped and started anticoagulant drugs, which effectively prevented the patient from the occurrence of thrombosis and postpartum hemorrhage complications. Meanwhile, based on evidence-based pharmacology, the clinical pharmacists analyzed the key points of pharmacological care for such patients during pregnancy and lactation. The standardized use of OAPS treatment drugs, such as hydroxychloroquine, aspirin and prednesone, have more advantages than disadvantages during pregnancy, but the corresponding adverse reactions need to be closely monitored. Enoxaparin does not accumulate in milk and can be used safely during lactation. The clinical pharmacists play an important role in guaranteeing the safety and effectiveness of medication for pregnant and lactation patients.

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