摘要
目的:总结临床药师参与门诊和住院患者抗凝规范化管理中的经验.方法:对2014年11月至2019年3月在中国医学科学院阜外医院接受规范化抗凝管理患者的相关资料进行回顾性分析.在此期间,临床医师和药师联合出抗凝门诊,对需要抗凝治疗的患者进行规范化管理.结果:管理患者3072例,其中瓣膜病患者1667例,心房颤动患者1024例,血栓性疾病患者381例,抗凝门诊共接诊患者9260例次.机械瓣和风湿性二尖瓣狭窄患者全部应用华法林抗凝,有抗凝指征并接受抗凝治疗的心房颤动患者中,68.16%应用华法林;而在接受抗凝治疗的血栓栓塞性疾病患者中,22.05%应用了利伐沙班.达比加群酯和利伐沙班应用的比例逐年增加.随访次数≥6次服用华法林的171例心房颤动患者中,国际标准化比值在目标范围内时间百分比为(73.21±0.17)%.临床相关非大出血发生率为0.49%,大出血发生率为0.24%,0.10%患者发生脑梗塞.结论:临床医师、药师联合的抗凝门诊及药师对患者的管理有助于提高患者抗凝药物的安全性和依从性.
Objectives: To summarize the experience of the standardized management of anticoagulation in outpatients and inpatients by physicians in collaboration with pharmacists. Methods: The patients who received standardized anticoagulation management under the guidance of physicians in collaboration with pharmacists in Fuwai Hospital from November 2014 to March 2019 were retrospectively analyzed. Results: The anticoagulation management for patients, who need anticoagulation therapy, was achieved by inpatient and outpatient education by physicians in collaboration with pharmacists, and the key nodes in the management process are sorted out and improved. There were 9 260 outpatient visits of 3 072 patients in our anticoagulation clinic, including 1 667 patients with valvular disease, 1 024 patients with atrial fibrillation and 381 patients with thromboembolic disease. The visits of patients with valvular disease, atrial fibrillation and thromboembolic disease were 3 993, 4 091 and 1 176, respectively. Warfarin is still irreplaceable in the treatment of valvular disease, especially for the patients with mechanical heart valves or rheumatic mitral stenosis. Majority of patients with atrial fibrillation received warfarin (68.16%). Rivaroxaban is the main treatment option for venous thromboembolic diseases (22.05%). There is a trend of medication increase with dabigatran and rivaroxaban. Among 171 AF patients treated with warfarin and clinical visits ≥6, the time of INR remained under the target range was (73.21±0.17)%, clinical relevant non-major bleeding rate was 0.49%, major bleeding rate was 0.24% and 0.10% patients suffered from cerebral infarct. The decision-making and choice of drugs are mainly influenced by the changes of guidelines, preferences of physicians and patients, drug cost and payments of medical insurance. Conclusions: The anticoagulation management led by combined decision making by pharmacists and physicians improves patients' medication safety and adherence. Drug cost, convenience of use and payment mode of medical insurance are the most important factors affecting the choice of anticoagulants. Strengthening pharmaceutical care and improving drug adherence are important strategies to improve the quality of anticoagulation.
作者
郑英丽
丁征
于欢
王莹
潘文斐
陈星伟
ZHENG Yingli;DING Zheng;YU Huan;WANG Ying;PAN Wenfei;CHEN Xingwei(Department of Pharmacy,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing,100037,China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第10期951-955,共5页
Chinese Circulation Journal
关键词
抗凝门诊
抗凝管理
华法林
新型口服抗凝药物
医保控费
anticoagulation clinic
anticoagulation management
warfarin
new oral anticoagulants
reduce the cost of medical insurance
