南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (04): 544-549.doi: 10.12122/j.issn.1673-4254.2020.04.15

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临床药师的抗凝监护可提高住院患者华法林治疗的有效性和安全性

黄珈雯，张志东，黄成锋，李小辉，张晓慎，陆 华   

  • 出版日期:2020-04-30 发布日期:2020-04-20
  • 基金资助:

Pharmacist-led anticoagulation monitoring can significantly improve the effectiveness and safety of warfarin for patients during hospitalization

  

  • Online:2020-04-30 Published:2020-04-20

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摘要： 目的 通过对住院接受华法林抗凝治疗的病例进行回顾性分析，考察临床药师抗凝监护在华法林临床安全合理应用方面的作用。方法 本研究共纳入2016年4月~2017年12月期间住院接受华法林抗凝治疗的患者421例。其中监护组316例在抗凝期间接受临床药师抗凝监护，包括凝血酶原时间国际标准（INR）等抗凝指标、运行医嘱审核及体征监护等。对照组患者105例，在院接受华法林治疗期间无临床药师进行抗凝监护。通过回顾性分析，对比监护组和对照组患者在院抗凝治疗过程中抗凝指标达标情况、预警值出现率与及时处理率、患者出血或栓塞事件发生率等方面的差异。结果 在院服用华法林抗凝治疗期间，经临床药师进行抗凝监护的监护组患者INR在目标范围内的时间百分比（TTR）明显高于对照组［（73.20±9.46）% vs（46.32±17.11）%，P<0.001］，其中患者出院前INR值达标率显著高于对照组（98.42% vs 60.95%，P<0.001），INR监测时机合理率也明显高于对照组（97.15% vs 66.67%，P<0.001）。同时，监护组患者INR预警值出现的比例远低于对照组（8.23% vs 20.00%，P< 0.001），且及时处理率显著优于对照组（96.15% vs 33.33%，P<0.001）。另外，本研究监护组患者在院抗凝治疗过程中除了小出血事件的发生率显著低于对照组（2.53% vs 9.52%，P=0.005），其他临床事件发生率未见明显差异。结论 临床药师的抗凝监护可有效提高住院患者华法林抗凝治疗的有效性和安全性。

Abstract: Objective To investigate the role of pharmacist-led anticoagulation monitoring service for warfarin anticoagulation therapy in patients during hospitalization. Methods We retrospectively analyzed the data of 421 patients receiving warfarin anticoagulation therapy during hospitalization between April, 2016 and December, 2017. Of these patients, 316 received daily pharmacist-led anticoagulation monitoring service including checking the patients’ International Normalized Ratio (INR) and other pertinent laboratory test results and reviewing medication changes and the patients’ clinical status (monitoring group); the other 105 patients receiving warfarin anticoagulation therapy without pharmaceutical care served as the control group. The data including compliance rate of anticoagulant indicators, incidence and rate of prompt management of INR alert, thrombosis and bleeding events during hospitalization were analyzed among these patients. Results Compared with the control patients, the patients in the monitoring group showed a significantly higher percentage time within target INR range [(73.20±9.46)% vs (46.32±17.11)%, P<0.001] and a higher qualified rate of INR before discharge (98.42% vs 60.95%, P<0.001) as well as a higher proper INR-monitoring frequency (97.15% vs 66.67%, P<0.001). The patients in the monitoring group showed a significantly lower incidence of INR alert than the control patients (8.23% vs 20.00% , P<0.001) with also a much higher rate of prompt management (96.15% vs 33.33% ). The two groups had similar incidences of clinical events except that the control group reported a higher incidence of minor bleeding episodes (9.52% vs 2.53%, P=0.005). Conclusion Pharmacist-led anticoagulation monitoring service can significantly improve the effectiveness and safety of warfarin anticoagulation therapy for patients during hospitalization.