住院患者阿哌沙班临床应用调查分析  

Investigation and analysis of clinical application of apixaban in inpatients

作　　者：李晓宇 李芬 陈博雅[1] 张冬燕 赵淑娟[1] Li Xiaoyu;Li Fen;Chen Boya;Zhang Dongyan;Zhao Shujuan(Department of Pharmacy,Henan Provincial People′s Hospital,Zhengzhou 450000,China;Department of Pharmacy,the Central Hospital of Xinxiang,Xinxiang 453000,China;Department of Pharmacy,the First People′s Hospital of Xinxiang,Xinxiang 453000,China)

机构地区：[1]河南省人民医院药学部,河南郑州450000 [2]新乡市中心医院药学部,河南新乡453000 [3]新乡市第一人民医院药学部,河南新乡453000

出　　处：《实用药物与临床》2023年第7期620-625,共6页Practical Pharmacy and Clinical Remedies

基　　金：河南省科技厅科技攻关计划项目(212102310656);河南省医学科技攻关计划联合共建项目(LHGJ20210052)。

摘　　要：目的制定阿哌沙班临床应用合理性评价标准(以下简称“标准”),为规范其合理使用提供依据。方法汇总国内外阿哌沙班相关的临床指南及权威文献,并结合药品说明书形成“标准”。回顾性收集河南省人民医院2019年1月至2021年12月使用阿哌沙班的住院患者病例,根据“标准”对其适应证、用法用量、给药时机、相互作用、桥接转换等进行分析。结果系统检索PubMed、Web of Science、中国知网、万方和维普等数据库后,对最终纳入的11篇文献进行汇总分析,形成“标准”。纳入完整病例815份,用药合理率69.69%(568/815),使用科室主要集中在骨科(688/815,84.42%)。不合理病例数共计247例,按频数进行统计,实际发生频数共计259次,包括不适宜的超说明书用药96次(37.07%),给药频次不合理87次(33.59%),给药剂量不合理28次(10.81%),存在禁忌的药物相互作用31次(11.97%),给药时机不合理7次(2.70%),抗凝转换不合理6次(2.32%),禁忌证用药4次(1.54%)。结论住院患者阿哌沙班的临床使用现状与“标准”存在一定差距,主要集中在不适宜的超说明书用药、给药频次和给药剂量不合理。临床药师应及时关注阿哌沙班循证医学证据和临床指南的更新,积极参与药物管理,进一步规范阿哌沙班的临床应用。Objective To establish the evaluation criteria for the rational application of apixaban(hereinafter referred to as the“criteria”),and to provide a basis for regulating its rational use.Methods The relevant guidelines and authoritative literatures were summarized,and the“criteria”was developed by combining the package insert of apixaban at home and abroad.The medical records of patients who admitted to Henan Provincial People′s Hospital and were prescribed apixaban from January 2019 to December 2021 were collected retrospectively,and the indications,usage and dosage,time of administration,interactions,bridges and conversions were analyzed according to the“criteria”.Results Totally 11 literatures were summarized and analyzed to form the“criteria”after systematically searching PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang,VIP and other databases.A total of 815 medical cases were included,with the rational rate of 69.69%(568/815).The application of apixaban was mostly in orthopaedic department(688/815,84.42%).Totally 247 patients accepted inappropriate apixaban treatment,and the actual frequency was 259 according to the actual frequency of occurrence,including 94 times of unreasonable off-label(37.07%),87 times of unreasonable administration frequency(33.59%),28 times of unreasonable dosage(10.81%),28 times of contraindications with combined medications(11.97%),7 times of unreasonable administration timing(2.70%),6 times of unreasonable anticoagulation conversion(2.32%),and 4 times of medication contraindications(1.54%).Conclusion There exists a gap between the current application and the“criteria”for apixaban in the inpatients.It mainly lies in inappropriate off-label medication,unreasonable frequency and dosage.Clinical pharmacists should pay timely attention to the update of evidence-based medicine and clinical guidelines for apixaban,and participate in the management of medication,hence further standardizing the clinical application of apixaban.

关 键 词：阿哌沙班 评价标准 临床应用 

分 类 号：R969.3[医药卫生—药理学]