目的 探讨肿瘤化疗后血小板减少症患者的药学服务要点,为临床药师参与此类患者临床治疗提供参考。方法 临床药师参与1例化疗后血小板减少合并静脉血栓患者的抗凝过程,从抗凝药物的选择、剂量的调整,协助医师优化个体治疗方案。结果 选择阿加曲班替代抗凝治疗, 患者血小板逐步恢复,顺利出院。结论：临床药师通过提供个体化用药服务,提高肿瘤相关静脉血栓患者抗凝治疗的效果及用药安全性。

Objective To explore the key points of pharmaceutical care for patients with thrombocytopenia after tumor chemotherapy, and to provide reference for clinical pharmacists to participate in the clinical treatment of such patients. Methods Clinical pharmacists participated in the anticoagulation process of a patient with thrombocytopenia complicated with venous thrombosis after chemotherapy, and assisted doctors in optimizing individual treatment plan from the selection of anticoagulants and dosage adjustment. Results Agatraban was selected instead of anticoagulant therapy, and the patient"s platelets gradually recovered and discharged smoothly. Conclusion Clinical pharmacists can improve the effect of anticoagulant therapy and medication safety of patients with tumor-related venous thrombosis by providing individualized medication services.