O'Donnell James
Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612, USA.
J Pharm Pract. 2012 Feb;25(1):22-9. doi: 10.1177/0897190011431146.
Anticoagulants are powerful and unavoidably dangerous drugs that must be carefully selected, monitored, and evaluated. Every patient undergoing treatment is at risk of excess bleeding, since the primary purpose of this class of drugs is to decrease clotting through a variety of biochemical and pharmacological mechanisms. Under the best of circumstances, significant numbers of patients (∼10%) experience toxicity on traditional warfarin oral anticoagulants. Beyond the obvious type A pharmacological toxicity, heparin products carry a seemingly paradoxical/novel risk of increased coagulopathy with limb- and life-threatening thromboembolic injuries (heparin-induced thrombocytopenia [HIT]). As a result of the great toxicity risk, many patients suffer injuries, and litigation is threatened or initiated, frequently against pharmacists and their employers. This article reviews the therapeutic use of old and novel anticoagulants, lists the types of litigation related thereto, and discusses the HIT risk associated with heparin products treatment. Litigation can result from adverse drug reactions and toxicity from anticoagulants.
抗凝剂是强效且不可避免具有危险性的药物，必须谨慎选择、监测和评估。每一位接受治疗的患者都有出血过多的风险，因为这类药物的主要目的是通过多种生化和药理机制减少凝血。在最佳情况下，大量患者（约10%）会在使用传统华法林口服抗凝剂时出现毒性反应。除了明显的A型药理毒性外，肝素类产品还存在一种看似矛盾/新颖的风险，即会增加凝血病，并伴有肢体和生命威胁的血栓栓塞性损伤（肝素诱导的血小板减少症 [HIT]）。由于毒性风险巨大，许多患者会受到伤害，并且经常会针对药剂师及其雇主提起诉讼或受到诉讼威胁。本文回顾了新旧抗凝剂的治疗用途，列出了与之相关的诉讼类型，并讨论了与肝素类产品治疗相关的HIT风险。诉讼可能源于抗凝剂的药物不良反应和毒性。
