抗凝药物审方规则专家共识  

Expert consensus on prescription review rules of anticoagulants

作　　者：重庆市医院协会药事管理专业委员会 钱妍 赵春景 Pharmaceutical Administration Committee of Chongqing Hospital Association

机构地区：[1]不详 [2]重庆医科大学附属第二医院

出　　处：《中国药房》2023年第24期2951-2967,共17页China Pharmacy

基　　金：2023年国家临床重点专科项目(No.渝卫办发〔2023〕48号);重庆医科大学附属第二医院“宽仁英才-骨干人才”项目(No.重医二院党〔2022〕28号)。

摘　　要：目的为进一步规范抗凝药物的临床应用,提高医疗机构抗凝药物处方的审核效率提供参考。方法由重庆市医院协会药事管理专业委员会发起,重庆医科大学附属第二医院牵头,联合全国多个省份的相关领域专家,基于药品说明书建立12种常用抗凝药物的基础审方规则、警示级别及对应干预措施;针对基础审方规则中未涵盖的部分临床应用情况,在参考已有指南及专家共识的基础上,向来自全国8个省份22家医院的42名专家进行函询,形成共识。结果与结论基于药品说明书建立了普通肝素、依诺肝素钠、那屈肝素钙、达肝素钠、磺达肝癸钠、比伐芦定、阿加曲班、华法林、达比加群酯、利伐沙班、阿哌沙班、艾多沙班共12种抗凝药物的基础审方规则,以及超出基础审方规则的警示级别及对应干预措施。针对基础审方规则中未涵盖的部分临床应用情况,经过2轮专家函询,形成了17条审方推荐意见。随着临床研究的进展,本共识将会进一步更新和调整;此外,因本共识未涵盖抗凝药物在临床使用的所有情况,审方人员须针对患者具体情况进行个体化评估。OBJECTIVE To further standardize the clinical application of anticoagulants and provide reference for improving the efficiency of prescription review of anticoagulants in medical institutions.METHODS Initiated by the Pharmaceutical Administration Committee of Chongqing Hospital Association and led by the Second Affiliated Hospital of Chongqing Medical University,in collaboration with experts in relevant fields from multiple provinces across the country,the prescription review rules,warning levels,and intervention measures for 12 kinds of common anticoagulants were established based on drug instructions.Regarding clinical drug use that was not covered by the basic review rules,based on reference to existing guidelines and expert consensus,42 experts from 22 hospitals in 8 provinces across the country were consulted by letter to form a consensus.RESULTS&CONCLUSIONS The basic prescription review rules of 12 kinds of anticoagulants,including unfractionated heparin,enoxaparin sodium,nadroparin calcium,dalteparin sodium,fondaparinux sodium,bivalirudin,argatroban,warfarin,dabigatran etexilate,rivaroxaban,apixaban and edoxaban,had been established according to drug instruction,as well as warning levels beyond the basic review rules and corresponding intervention measures.After two rounds of expert consultation,17 recommendations for prescription review were formed regarding some clinical drug use that were not covered by the basic prescription review rules.With the progress of clinical research,this consensus will be further updated and adjusted;in addition,as this consensus does not cover all situations where anticoagulants are used in clinical practice,prescription reviewer must conduct personalized evaluations based on the specific situation of the patient.

关 键 词：抗凝药物 处方适宜性 审方规则 临床应用 专家共识 

分 类 号：R95[医药卫生—药学] R972R973