药学服务对华法林抗凝治疗效果与安全性的影响  

Effect and safety of warfarin anticoagulant therapy in pharmaceutical care

作　　者：兰艳纤[1] 陆海鹏[1] 吕聪[1] 曾尚勇[1] 罗秀[1] LAN Yanxian;LU Haipeng;LYU Cong;ZENG Shangyong;LUO Xiu(Department of Clinical Pharmacy,Minzu Hospital of Guangxi Zhuang Autonomous Region/The Affiliated Minzu Hospital of Guangxi Medical University,Nanning,Guangxi 530001,China)

机构地区：[1]广西壮族自治区民族医院临床药学科<广西医科大学附属民族医院>,广西南宁530001

出　　处：《医药前沿》2023年第18期1-4,共4页Journal of Frontiers of Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题,Z20200981。

摘　　要：目的:探讨药学服务对华法林抗凝治疗效果与安全性的影响,为临床药师开展抗凝药学服务提供参考。方法:选取2020年7月—2021年12月广西壮族自治区民族医院住院期间使用华法林抗凝治疗的患者437例。采用随机数字表法分为传统抗凝管理的对照组(n=220)和临床药师实施药学服务的干预组(n=217)。比较两组患者的国际标准化比值(INR)达标情况、达标时间百分比(TTR)、抗凝知晓率、主要终点事件等情况。结果:干预组患者INR达标时间短于对照组患者,出院INR达标率高于对照组患者,差异均有统计学意义(P<0.05)。干预组患者TTR高于对照组患者,TTR≥70%的患者比例高于对照组患者,差异均有统计学意义(P<0.05)。干预组总缺血事件、静脉血栓、心肌梗死发生率均低于对照组,差异有统计学意义(P<0.05)。干预组的总出血事件发生率低于对照组,差异有统计学意义(P<0.05)。临床药师提供药学服务后,抗凝认识差的患者从42.4%降低到10.60%,抗凝认识评分优秀的患者占比从12.90%升高到29.95%;患者的抗凝认识程度优于临床药师提供药学服务前,差异有统计学意义(P<0.05)。结论:药学服务可显著提高华法林抗凝治疗效果及抗凝安全性。Objective To evaluate the impact of pharmaceutical services on the efficacy and safety of warfarin anticoagulant therapy,and provide reference for clinical pharmacists to carry out anticoagulant pharmaceutical services.Methods From July 2020 to December 2021,437 patients who were treated with warfarin anticoagulation during their hospitalization in Minzu Hospital of Guangxi Zhuang Autonomous Region were selected.According to the time of admission,they were divided into the control group of traditional anticoagulant management(n=220)and the intervention group of clinical pharmacists to implement pharmacy services(n=217).The international standardized ratio(INR)attainment,time in therapeutic range(TTR),anticoagulation awareness rate,and primary endpoint events of the two groups were compared.Results The intervention group exhibited a shorter time to achieve INR normalization compared to the control group,with a higher rate of INR normalization at discharge,and these differences were statistically significant(P<0.05).Patients in the intervention group had a higher time in therapeutic range(TTR)than those in the control group,and the proportion of patients with TTR≥70%was also higher in the intervention group,both differences being statistically significant(P<0.05).The intervention group showed lower rates of total ischemic events,venous thrombosis,and myocardial infarction compared to the control group,with statistically significant differences(P<0.05).The overall bleeding rate in the intervention group was lower than that in the control group,and this difference was statistically significant(P<0.05).Following pharmaceutical services provided by clinical pharmacists,the proportion of patients with poor anticoagulation awareness decreased from 42.4%to 10.60%,while the proportion of patients with excellent anticoagulation awareness scores increased from 12.90%to 29.95%.The level of anticoagulation awareness among patients improved significantly after receiving pharmaceutical services from clinical pharmacists(P<0.05

关 键 词：药学服务 华法林 抗凝效果 安全性 

分 类 号：R9[医药卫生—药学]