药师参与抗凝服务对华法林治疗管理的效果评价

Impact of Pharmacist-Participated Anticoagulation Service on Warfarin Therapy Management: A Systematic Review

目的系统的评价药师参与的抗凝服务对华法林治疗管理的作用。方法计算机检索OVID、SCI、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文期刊数据库(VIP)数据库,万方数据库(WANFANG),纳入药师参与的抗凝服务对华法林治疗管理作用的随机对照试验,检索时间从建库至2014年1月。系统筛选文献、提取资料及评价质量后,采用Rev Man5.0软件进行Meta分析。结果共纳入9个随机对照试验,1 630例患者。Meta分析结果显示,试验组与对照组结局指标:精确的国际标准化比值(international normalized ratio,INR)治疗目标范围时间比、宽松的国际标准化比值治疗目标范围(目标INR±0.2)时间比、全因死亡率、主要出血事件发生率、血栓栓塞事件发生率差异均无统计学意义,效应量依次为MD=1.24,95%CI(-2.83,5.30),P=0.55;MD=2.86,95%CI(-1.52,7.25),P=0.20;RR=0.87,95%CI(0.40,1.91),P=0.73;RR=0.65,95%CI(0.32,1.34),P=0.24;RR=0.85,95%CI(0.40,1.78),P=0.66。而患者满意度指标显示患者对试验组的满意度高于对照组(P≤0.001)。结论基于当前证据,除能增加患者满意度外,药师参与的抗凝服务对华法林治疗管理的其他作用仍有待进一步的研究支持。

OBJECTIVE To assess systematically the impact of pharmacist-participated anticoagulation service on warfarin therapy management. METHODS Databases of the OVID,SCI,CBM,CNKI,VIP,WANFANG were searched,randomized controlled trials（ RCTs） of warfarin anticoagulation management by pharmacists were included（ up to January 2014）,systematically selected studies,extracted data and evaluated quality,then meta-analysis were carried out using Rev Man 5. 0 if there was homogeneity. RESULTS Nine RCTs were included,Meta-analysis indicated the differences of the percentage of the time spent within the therapeutic range,the percentage of the time spent within the extended therapeutic range（ target INR ± 0. 2）,the all-cause mortality,the incidence of the major bleeding complications and the incidence of the thromboembolic complications between groups were no significant： MD = 1. 24,95% CI（- 2. 83,5. 30）,P = 0. 55,MD = 2. 86,95% CI（- 1. 52,7. 25）,P = 0. 20,RR = 0. 87,95% CI（ 0. 40,1. 91）,P = 0. 73,RR = 0. 65,95% CI（ 0. 32,1. 34）,P = 0. 24,RR = 0. 85,95% CI（ 0. 40,1. 78）,P = 0. 66,in that order. However,the score of patients＇ satisfaction questionnaire indicated the trial group was well received by the patient（ P≤0. 001）. CONCLUSION Based on current clinical evidence,besides increasing patients＇ satisfaction,the other positive effects of pharmacist-participated anticoagulation service on warfarin therapy management still needs further research.