住院患者华法林临床应用情况调查及分析

Investigation about clinical application of warfarin in hospitalized patients

目的了解华法林在我院住院患者的临床应用情况,分析临床用药特点,为临床药师开展抗凝治疗管理提供参考。方法收集我院2014年住院期间使用华法林患者的病历资料321份,并对华法林应用的适应证、用药情况、国际标准化比值(INR)监测、出血并发症及合并用药等进行回顾性分析。结果我院华法林主要用于非瓣膜病心房颤动、静脉血栓栓塞和肺栓塞等,心内科是重点应用科室。患者的年龄为(70.4±12.5)岁,华法林用药剂量范围0.625~6.25 mg·d^(-1),INR值波动在0.81~8.09,其中INR值在1.5~3的仅占16.2%。应用华法林发生出血并发症的发生率为32.71%,主要是尿隐血。患者合并用药主要有活血中成药、抗凝药、抗血小板药,以及抗菌药物等,合并使用2~4种药物的患者人数最多,占到69.23%。结论目前我院华法林使用中不少细节问题没有引起重视,临床药师应充分发挥自身专业优势,积极开展抗凝药物治疗的规范化管理,降低患者抗凝治疗风险。

AIM To investigate the clinical application of warfarin in patients of our hospital, analyze the charac- teristics of clinical medicine, and provide some reference for anticoagulation management of clinical pharmacists. METH- ODS A total of 321 cases history of patients with warfarin in 2014 of our hospital were consulted, to retrospectively ana- lyze the indication, medication, international normalized ratio （ INR）, hemorrhage event and drugs used in conrbination with warfarin systematically. RESULTS The clinical indications for warfarin use in our hospital were nonvalvular atrial fibrillation, vein thrombosis and pulmonary embolism, et al. Warfarin was mainly applied in department of cardiology. The average age of patients was （70.4± 12.5） years old.The dosage of warfarin used in patients was between 0. 625 - 6.25 mg＇d-l.The INR fluctuated between 0.81 -8.09, and the patients with INR between 1.5 -3 accounted for only 16.2%. The hemorrhage events which happened in patients with warfarin were mainly uric concealed blood, its incidence was 32.71 % .The patients commonly took warfarin combined with other drugs, such as blood-activating Chinese patent medicines, anticoagulant drugs, antiplatelet drugs and antimicrobial agents, et al. The combined use of 2- 4 kinds of drugs accounted for 69.23 % in patients. CONCLUSION At present, some details of warfarin use are not taken serious- ly. In order to reduce the risk of anticoagulant therapy in patients, clinical pharmacists should give full play to their profes- sional advantage, and actively develop the standardized management of anticoagulant therapy.