This paper reports the clinical pharmacist's participation in the treatment of a patient with lower extremity deep venous thrombosis (DVT) after atrial septal defect (ASD) occlusion. The patient developed lower extremity venous thrombosis after ASD occlusion. The clinical pharmacist evaluated the risk of thrombus and bleeding referring to the domestic and foreign literature and considering the patient's age, symptoms, liver and kidney function and medical history. They suggested that the patient was given antithrombotic therapy of nadroparin calcium injection combined with aspirin. Iliac vein thrombosis and cardiac thrombosis were excluded during hospitalization. The patient's symptoms of lower extremity DVT were significantly improved, hence the antithrombotic therapy was not further adjusted. After the antithrombotic therapy, the swelling in the patient's lower extremities had subsided, and the lower extremity DVT was effectively controlled, with no bleeding points observed throughout the body. The patient was discharged from hospital, and the clinical pharmacist suggested the antithrombotic therapy plan that was aspirin combined with rivaroxaban for 3-6 months, and advised the patient to pay attention to the bleeding tendency during medication. The clinician adopted the suggestion. After discharge, venous bilateral doppler ultrasonography of lower extremity showed no evidence of deep vein thrombosis. The clinical pharmacist assisted clinicians to develop individualized antithrombotic therapy and conducted the whole process of pharmaceutical care. This controlled the patient’s condition effectively, ensured the safety and effectiveness of drug use, and could provide reference for the management of antithrombotic therapy in patients with venous thrombosis after ASD occlusion.
1.国家卫生健康委员会国家结构性心脏病介入质量控制中心, 国家心血管病中心结构性心脏病介入质量控制中心, 中华医学会心血管病学分会先心病经皮介入治疗指南工作组, 等. 常见先天性心脏病经皮介入治疗指南(2021版)[J]. 中华医学杂志, 2021, 101(38): 3054-3076. DOI: 10.3760/cma.j.cn112137-20210730-01696.
2.Stevens SM, Woller SC, Baumann Kreuziger L, et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report[J]. Chest, 2021, 160(6): 2247-2259. DOI: 10.1016/j.chest.2021.07.056.
3.Luermans JG, Post MC, Yilmaz A. Late device thrombosis after atrial septal defect closure[J]. Eur Heart J, 2010, 31(2): 142. DOI: 10.1093/eurheartj/ehp512.
4.Chessa M, Carminati M, Butera G, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect[J]. J Am Coll Cardiol, 2002, 39(6): 1061-1065. DOI: 10.1016/s0735-1097(02)01711-4.
5.Uysal F, Bostan ÖM, Şenkaya Sığnak I, et al. Huge thrombus formation 1 year after percutaneous closure of an atrial septal defect with an amplatzer septal occluder[J]. Anatol J Cardiol, 2016, 16(1): 63-64. DOI: 10.14744/AnatolJCardiol.2015.6538.
6.Giraldo-Gonzalez GC, Olaya P, Domínguez A, et al. Very late amplatzer device thrombosis and stroke[J]. CASE (Phila), 2019, 4(1): 25-27. DOI: 10.1016/j.case.2019.09.008.
7.Xiong W, Tang L, Long W, et al. Case report: bi-atrial thrombus after occlusion of atrial septal defect with acute cerebral infarction and pulmonary embolism[J]. Front Cardiovasc Med, 2022, 9: 987538. DOI: 10.3389/fcvm.2022.987538.
8.Akagi T. Current concept of transcatheter closure of atrial septal defect in adults[J]. J Cardiol, 2015, 65(1): 17-25. DOI: 10.1016/j.jjcc.2014.09.002.
9.王海勇, 金涛, 查育新. 房间隔缺损介入封堵术后远期并发左房血栓、下肢动脉栓塞一例[J]. 中华心血管病杂志, 2005, 33(3): 278. [Wang HY, Jin T, Zha YX. A case with long-term complications of left atrial thrombus and lower extremity artery embolism after interventional closure of atrial septal defect[J]. Chinese Journal of Cardiology, 2005, 33(3): 278.] DOI: 10.3760/j:issn:0253-3758.2005.03.027.
10.Shabestari MM, Kerachian A, Poorzand H, et al. Trans-catheter closure of ASD and abnormal connection of left pulmonary vein to vertical vein: a case report[J]. Medicine (Baltimore), 2022, 101(42): e31011. DOI: 10.1097/MD.0000000000031011.
11.Murala J, Sassalos P, Si MS. 'Near death' thromboembolic episode following device closure of atrial septal defect[J]. Interact Cardiovasc Thorac Surg, 2016, 23(2): 340-341. DOI: 10.1093/icvts/ivw145.
12.Baspinar O, Al-Hadidy KI, Kervancioglu M. Transjugular closure of a two-hole atrial septal defect in a child with iliac vein thrombosis[J]. Ann Pediatr Cardiol, 2013, 6(2): 185-187. DOI: 10.4103/0974-2069.115280.
13.Farhat K, Farhat N, Bruyère PJ, et al.. Vena cava inferior thrombosis diagnosed 12 years after interventional atrial septum defect closure in an infant[J]. Acta Cardiol, 2024, 79(1): 70-71. DOI: 10.1080/00015385.2023.2177372.
14.Disli OM, Erdil N, Akca B, et al. Large thrombus formation from right atrial incision site after closure of atrial septal defect[J]. Korean Circ J, 2013, 43(12): 842-844. DOI: 10.4070/kcj.2013.43.12.842.
15.王毅, 覃军, 黄岚, 等. 两种抗凝方案下房间隔缺损封堵术后纤溶功能动态变化及意义[J]. 第三军医大学学报, 2012, 34(10): 980-982. [Wang Y, Qin J, Huang L, et al. Effects of the fibrinolytic on two different anticoagulation protocols after transcatheter closure of atrial septal defects[J]. Journal of Army Medical University, 2012, 34(10): 980-982.] DOI: 10.16016/j.1000-5404.2012.10.015.
16.Zeng XC, Wu WF, Huang K, et al. Enhanced prothrombin formation and platelet activation in Chinese patients after transcatheter closure of atrial septal defect[J]. Clin Cardiol, 2010, 33(7): E6-E9. DOI: 10.1002/clc.20752.
17.Rodés-Cabau J, Palacios A, Palacio C, et al. Assessment of the markers of platelet and coagulation activation following transcatheter closure of atrial septal defects[J]. Int J Cardiol, 2005, 98(1): 107-112. DOI: 10.1016/j.ijcard.2004.03.022.
18.Bhukar RK, Gowda D, Rao JN, et al. Management of atrial thrombus formation following surgical closure of an atrial septal defect[J]. J Card Surg, 2017, 32(8): 476-478. DOI: 10.1111/jocs.13184.
19.Yorgun H, Canpolat U, Kaya EB, et al. Thrombus formation during percutaneous closure of an atrial septal defect with an Amplatzer septal occluder[J]. Tex Heart Inst J, 2011, 38(4): 427-430. https://pubmed.ncbi.nlm.nih.gov/21841876/
20.尚小珂, 张刚成, Liang Z, 等. 房间隔缺损介入封堵术后抗凝和抗血小板聚集的策略[J]. 临床心血管病杂志, 2015, 31(2): 184-187. [Shang XK, Zhang GC, Liang Z, et al. The strategy of anticoagulation and anti-platelet aggregation after transcatheter closure of atrial septal defect again[J]. Journal of Clinical Cardiology (China), 2015, 31(2): 184-187.] DOI: 10.13201/j.issn.1001-1439.2015.02.019.
21.Sun HR, Tang H, Song HB. Ball thrombus in the right atrium after patch closure of atrial septal defect[J]. Heart Lung Circ, 2014, 23(6): e152-e153. DOI: 10.1016/j.hlc.2014.02.001.
22.王利媛, 王法财, 李平. 1例重症肺炎合并心室内血栓、肺栓塞的高肾脏排泄率患儿抗血栓治疗与药学监护[J]. 药物流行病学杂志, 2024, 33(8): 938-943. [Wang LY, Wang FC, Li P. Analysis of antithrombotic therapy and pharmaceutical care in a child with severe pneumonia complicated with intraventricular thrombosis and pulm onary embolism with high renal excretion rate[J]. Chinese Journal of Pharmacoepidemiology, 2024, 33(8): 938-943] DOI: 10.12173/j.issn.1005-0698.202406014.