华法林抗凝门诊成效分析与评价

Analysis and evaluation of the effectiveness of warfarin anticoagulantion clinic

目的探讨华法林抗凝门诊对患者抗凝达标率及依从性方面的影响。方法研究对象为2014年7月—2016年12月在梧州市人民医院心血管内科、肾内科以及门诊接受华法林抗凝治疗,并且随访期(6个月)内仍需持续服用华法林的50例患者。按实验设计的随机化分组,分为随访组(n=25)和对照组(n=25)。对随访组患者采取门诊约定随访为主,电话随访为辅,建立随访记录表用以记录药师随访干预情况;对照组患者仅观察记录INR值、不良事件等指标,不进行药师随访。结果监测周期内,随访组抗凝达标的例数(18例)高于对照组(10例)(P<0.05);随访组从未达到稳定剂量到连续监测两次国际标准化比值(INR)均达标所需时间[(49.0±43.9)d]短于对照组[(99.0±63.8)d](P<0.05);随访组未按医嘱服药(包括失联、非医嘱停药、服药未按时复查INR)的例数(6例)少于对照组(13例)(P<0.05);随访组与对照组均发生1例严重出血不良反应,需门诊注射维生素K1注射液,两组不良反应比较差异无统计学意义。随访期间,所有患者均未出现因血栓栓塞再次住院的不良事件。结论华法林抗凝门诊,对患者的用药依从性和抗凝达标率起到积极作用,临床药师主动监测用药合理性和安全性,提供药学干预或许有助于降低药物不良反应的发生率。

Objective To explore the effects of warfarin anticoagulation clinic on the international normalized ratio（INR）target achievement rate and patients compliance during anticoagulation treatment. Methods The objects of this study were 50 patients who received warfarin anticoagulant therapy from July 2014 to December 2016 in Cardiovascular,Nephrology and Outpatient Departments of People＇s Hospital of Wuzhou City and continued to use warfarin during the follow-up period（6 months）.Patients were randomly divided into a follow-up group（n=25）and a control group（n=25）according to the experimental design.The patients in the follow-up group were mainly followed up by outpatient appointment and supplemented with telephone follow-up.The follow-up record forms were established for recording the clinical pharmacist intervention outcomes.For the patients in the control group,only the indexes such as INR value and adverse events were observed and recorded,and the follow-up by pharmacist was not performed. Results During the monitoring period,more patients reached to the INR target achievement in the follow-up group（18 cases）than the control group（10 cases）（P〈0.05）.For the follow-up group the required time from not reaching a stable dose to reaching the of INR target achievement for two consecutive monitoring was（49.0±43.9）d that was shorter than that of the control group（99.0±63.8）d（P〈0.05）.The number of patients in the follow-up group（6 cases）who did not take the prescribed medicine（including missing,stopping the medicine without doctor＇s advice,taking medicine but failing to review INR on time）was lower than that of the control group（13 cases）（P〈0.05）.One case of severe haemorrhage adverse event occurred in both the follow-up group and the control group and the injection of Vitamin K1 injection was required in clinic,and the difference was not statistically significant.During the follow-up period,none of the patients were re-hospitalized due to the adverse event of thromboembolism. Conclusion Warfarin anticoagulation clinic plays a positive role in patients＇ drug compliance and（INR）target achievement rate.Clinical pharmacists actively monitor the rationality and safety of drug use and provide pharmacological interventions that may help reduce the occurrence rate of drug adverse events.