179例心房颤动住院患者华法林应用情况

Current Application of Warfarin in 179 Hospitalized Patients with Atrial Fibrillation

目的回顾性分析非瓣膜性心房颤动(房颤)住院患者华法林应用情况,探讨临床药师在华法林治疗中的作用。方法查阅武汉大学人民医院2013年1—12月非瓣膜性房颤住院患者病历179份,对华法林使用率、抗血栓治疗情况、华法林用药剂量、国际标准化比值(INR)监控率、不良反应等情况进行回顾性调查统计。分析年龄、并发的慢性疾病、既往脑血管事件等单因素对华法林使用率的影响。结果该院住院高危非瓣膜性房颤患者总抗血栓治疗率85.6%(华法林使用率27.3%,抗血小板治疗率58.3%),住院期间首次发现房颤患者的华法林使用率19.1%。INR的总监测率89.8%,INR达标率11.9%。华法林使用单因素分析提示高龄、并发高血压对华法林的使用有较大的影响。结论该院非瓣膜性住院患者总体抗血栓治疗情况较好,但华法林使用率(新发房颤华法林使用率)及INR达标率较低。临床药师应针对这些问题开展相应的学习及宣教,积极参与、开展抗凝管理工作,以提高华法林抗凝治疗的安全性和有效性。

Objective To retrospectively analyze the current application of warfarin in hospitalized patients with nonvalvular atrial fibrillationand( NVAF),and explore the key role of clinical pharmacists in warfarin medication. Methods A retrospective survey of anticoagulant therapy for 179 hospitalized patients with non-valvular atrial fibrillation in Renming Hospotal of Wuhan University from January to December 2013 was retrived,including the usage of warfarin for NVAF and antithrombotic therapy,the dose of warfarin,international normalized ratio( INR),hemorrhage event and so on. The simple factor like the age,complicated chronic diseases and previous cerebrovascular events on the use of warfarin was explored. Results The total response rate to anticoagulants was 85.6% for patients with high risk of stroke( 27.3% with warfarin and 58.3% with antiplatelet therapy),who are recommended to use warfarin,patients were treated with anti-thrombotic therapy. The total of 19. 1% of the patients with new-onset atrial fibrillation used warfarin as therapy. The whole monitoring rate of INR was 89. 8%,and the good control rate was 11.9%.Univariate analysis showed that some high risk factors such as age and high blood pressure affected the usage of warfarin. Conclusion The anti-thrombotic therapy for NVAF patients in the hospital is good,but usage of warfarin for those with new-onset atrial fibrillation is low,which couldn't reach the INR standard.More attention should be taken by the clinic pharmacists in effective managing the use of anticoagulant to build a safe,economic and effective medication system for warfarin application.