抗凝门诊临床药师管理的抗凝效果评价  

Evaluation of Anticoagulant Effects of Clinical Pharmacist Management in Anticoagulation Clinic

作　　者：李舒悦 回翔 金远香[3] 王娟 张欢[5] 王宝彦 徐航 LI Shuyue;HUI Xiang;JIN Yuanxiang;WANG Juan;ZHANG Huan;WANG Baoyan;XU Hang(Dept.of Pharmacy,Nanjing Drum Tower Hospital,Nanjing 210008,China;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210009,China;Clinical Pharmacy Laboratory,Huaihua First People’s Hospital,Hunan Huaihua 418000,China;Dept.of Pharmacy,Yili Friendship Hospital,Xinjiang Yili 835000,China;Dept.of Pharmacy,Nanjing Tongren Hospital Affiliated to Medical College of Southeast University,Nanjing 211102,China)

机构地区：[1]南京鼓楼医院药学部,南京210008 [2]中国药科大学基础医学与临床药学学院,南京210009 [3]怀化市第一人民医院临床药学研究室,湖南怀化418000 [4]伊犁州友谊医院药剂科,新疆伊犁835000 [5]东南大学医学院附属南京同仁医院药学部,南京211102

出　　处：《中国药房》2020年第18期2289-2293,共5页China Pharmacy

基　　金：江苏省药学会-Shire生物药学基金科研项目(No.S201606);十三五南京市卫生青年人才培养工程项目(No.QRX17060);南京大学医院管理研究所医院管理课题(No.NDYG2017012)。

摘　　要：目的:评价抗凝门诊临床药师管理的抗凝效果。方法:回顾性分析2019年8月-2020年1月南京鼓楼医院(以下简称“我院”)抗凝门诊就诊的481例患者的病历资料,记录其基本信息(性别、年龄、患者分级)、使用的抗凝药物、抗凝原因、抗凝相关检查结果[凝血酶原时间、国际标准化比值(INR)等]、华法林剂量、新型口服抗凝药物(NOACs)使用情况及不良反应发生情况等。结果:481例患者于我院抗凝门诊就诊共1587例次。患者分级分别为一级401例次、二级547例次、三级639例次。470例患者服用华法林,11例服用NOACs(包括6例利伐沙班、5例达比加群酯)。瓣膜置换术为抗凝的主要原因(65.28%),其次为心房颤动(14.97%)、瓣环修复术(12.47%)。凝血酶原时间检测方法以即时检测设备检测为主(83.44%)。三级患者华法林日平均剂量为(3.03±1.28)mg。使用华法林患者的平均INR为1.99±0.56,INR在目标范围内的时间百分比(TTR)为72.79%,其中一级患者平均INR为2.12±0.84、TTR为44.33%,二级患者平均INR为1.95±0.52、TTR为72.34%,三级患者平均INR为1.94±0.33、TTR为90.42%。患者发生小出血102例次(6.43%),发生临床相关非大出血2例次(0.13%),未见大出血和血栓栓塞事件发生。结论:我院抗凝门诊临床药师通过实行分级管理,为患者制定科学的管理措施并进行个体化问诊;患者不良反应症状较轻且发生率较低,服用华法林患者的TTR较高,临床药师管理的抗凝效果明显。OBJECTIVE:To evaluate the anticoagulant effect of clinical pharmacist management in clinic.METHODS:Retrospective analysis was performed on medical records of 481 patients in anticoagulant clinic of Nanjing Drum Tower Hospital(hereinafter referred as“our hospital”)from Aug.2019 to Jan.2020.The general information(gender,age,patient grading)of patients,anticoagulant drug,anticoagulant causes,anticoagulant examination[prothrombin time,international standardized ratio results(INR)],warfarin dose,NOACs usage and ADR were recorded.RESULTS:Totally 481 patients visited anticoagulant clinic of our hospital for 1587 times in total.The case number of primary,secondary and tertiary patients were 401,547 and 639,respectively.470 patients received warfarin,and 11 patients received NOACs(including 6 cases of rivaroxaban,5 cases of dabigatran etexilate).The valve replacement was the main cause of anticoagulation(65.28%),followed by atrial fibrillation(14.97%),valve ring repairment(12.47%).The main detection method of prothrombin time was POCT(83.44%).Their average dose of warfarin was(3.03±1.28)mg.The average INR of outpatients receiving warfarin was 1.99±0.56,and time within treatment range(TTR)was 72.79%.The average INR of the first grade was 2.12±0.84 and the TTR was 44.33%;the average INR of the second grade was 1.95±0.52 and the TTR was 72.34%;the average INR of the third grade was 1.94±0.33 and the TTR was 90.42%.There were 102 cases(6.43%)of small bleeding,and 2 cases(0.13%)of clinical related non major bleeding;no major bleeding and thromboembolism was observed.CONCLUSIONS:Clinical pharmacists of anticoagulant clinic in our hospital formulate scientific management and provide individualized consultation for patients through implementing hierarchical management of patients.Patients show mild symptoms and low incidence of adverse reactions;the patients taking warfarin have higher TTR;clinical pharmacist management has significant anticoagulant effect.

关 键 词：抗凝门诊 临床药师 抗凝效果 分级管理 华法林 新型口服抗凝药 

分 类 号：R973.2[医药卫生—药品]