| ABSTRACT Objective:The clinical pharmacist’s work mode was investigated. Clinical pharmacist participated in the drug treatment of patients with clopidogrel resistance.Methods:Clinical pharmacists participating in the treatment of one clopidogrel resistant patient with non mutated in CYP2C19. The result of thromboela stogram was not consistent with the result of the clopidogrel gene polymorphism test. As the TEG shown, the inhibition rate of clopidogrel was 25.2%, MADP was 57 mm. The clopidogrel gene polymorphism test showed that CYP2C19*2 GG，CYP2C19*3 GG，CYP2C19*17 GG，ABCB1 3435 TT，and PON1 576 AA. Combined with the actual situation of patients, and comprehensive analysis of the patient's condition, to achieve accurate drug therapy, clinical pharmacists developed an individualized medication program, and adjusted the anti platelet therapy program. What's more, taking the economic situation of the patient into account, clinical pharmacists replaced clopidogrel for ticagrelor. Results:The patient was followed up for 1 year. The cardiovascular events or adverse events such as gastrointestinal bleeding were not reported in the period. Conclusion:Clinical pharmacists participated in the development of individualized treatment programs for patients with clopidogrel resistance, such as adjusting anti platelet therapy for patients, providing directions of drugs, and so on. It ensured the safe, effective, reasonable and precise clinical use of drugs. |
