服用华法林患者用药合理性、安全性和依从性评价

Assessment of Rationality, Safety and Adherence in Warfarin's Clinical Application

目的了解服用华法林患者住院期间用药合理性,出院后用药安全性及依从性,为更安全、合理地使用华法林提供研究基础。方法对2015年1月1日至2015年12月31日入住某院东区心内科的所有使用华法林患者的病历进行系统的回顾性调查,进行用药合理性评价。采用电话随访方式,对以上患者出院后华法林服用、监测情况进行调查,进行安全性、依从性评价。结果 2015年心内科使用华法林的患者共计139例,其中男性65例,女性74例;年龄36~87岁,平均（68.52±10.02）岁。住院期间38.30%的患者华法林剂量调整幅度偏大;INR检测间隔合理者76例,不合理者63例;出院时,INR达标率为32.59%;出院医嘱中明确凝血功能具体复查日期者占42.98%。139例患者中,对122例进行回访,失联患者17例。回访的122例患者中,9例非医嘱停药,8例发生不良反应,末次INR达标率为64.76%。结论患者住院期间华法林使用主要存在凝血功能检测间隔长、出院时INR达标率低的现象;出院后患者对凝血功能监测依从性也较低。可通过加强用药教育及长期随访以提高华法林抗凝治疗的安全性和依从性。

Objective To evaluate the rationality of warfarin application in hospitalized patients, as well as the safety and adherence when they leaved hospital, obtain foundation for further research. Methods A sophisticated research was conducted on all patients who were admitted to the department of cardiology from Jan. 1st, 2015 to Dec. 31 st, 2015 and had record of warfarin usage. In the research, we analyzed their cases retrospectively and systematically, assessing the rationality of their warfarin application in hospital. We also investigated their specific warfarin usage and their intervals of repeated International Normalized Ratio（INR） testing by telephone follow-up method, assessing the safety and adherence of their warfarin application at discharge time. ResultsA total of 139 patients（65 males and 74 females, ages ranging from 36 to 74, average age（68.52±10.02）） were enrolled in this research. When hospitalized, 38.30% of the patients had large-range warfarin dose adjustment, 76 patients had reasonable INR testing results and 63 had unreasonable results. When leaving the hospital, only 32.59% of the patients met the INR intensity goals, 42.98% of the patients were advised by their doctors to determine blood coagulation function on specific dates at discharge time. Among the 122 patients（17 patients unable to contact） who were investigated by phone calls at discharge time, 9 patients stopped taking pills without doctors＇ instructions, 8 patients had adverse reactions, and 64.76 % of patients＇ latest INR met targets. Conclusion The main problems of warfarin application are as follows： determined INR infrequently when hospitalized, low ratio of meeting target INR intensity when leaving hospital, and weak adherence of regular INR monitoring. Medication education and long-term telephone follow-up on patients may improve the safety and adherence of warfarin application.