全程化药学服务改善非瓣膜性心房纤颤患者达比加群酯抗凝效果及安全性的研究

The influence of integrated anticoagulant pharmaceutical care on anticoagulant therapy of dabigatran etexilate for patients with nonvalvular atrial fibrillation

目的观察全程化药学服务对非瓣膜性心房纤颤(NVAF)患者服用达比加群酯后抗凝效果及安全性的影响。方法前瞻性收集2016年10月至2018年9月在广州市番禺区何贤纪念医院就诊的NVAF患者的临床资料,随机分为药学服务组和常规组,分别给予全程化药学服务及基本用药教育。所有患者均给予达比加群酯110 mg 2次/d口服,观察服药后1个月、3个月的凝血指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]及临床事件(脑栓塞、脑出血、其余部位栓塞、死亡)及药物不良反应(肝、肾功能异常,贫血,非致命性出血,消化道反应)。结果共纳入符合标准的患者53例,两组患者的年龄、性别构成比、体重指数、丙氨酸氨基转移酶、肌酐清除率及凝血指标等无显著差异(P> 0. 05)。与常规组相比,药学服务组的APTT和TT较治疗前延长程度更明显,组间差异均具有统计学意义(P <0. 05);两组患者均未出现脑栓塞、脑出血、其余部位栓塞、死亡等临床事件;药物不良反应发生率药物服务组7. 41%,常规组19. 23%,两组差异无统计学意义(P> 0. 05)。结论开展全程化药学服务可提高NVAF患者对抗凝药物的认识,改善抗凝效果,有助于降低药物不良反应发生率,具有良好应用前景。

Objective To investigate the effect and safety of integrated anticoagulant pharmaceutical care in patients with nonvalvular atrial fibrillation(NVAF)who accepted anticoagulant therapy of dabigatran etexilate.Methods The clinical data of patients with NVAF was collected from October 2016 to September 2018.Patients were randomly divided into pharmacy service group and routine group,who were provided by integrated anticoagulant pharmaceutical care and basic medication education,respectively.All patients were given a dose regimen of 110 mg twice daily.The coagulation indexes(APTT,TT),clinical events(stroke,cerebral hemorrhage,embolism in other parts,death)and adverse drug reactions(renal and liver impairment,anemia,non-major bieeding,gastrointestinal discomfort)were observed after 1 and 3 months.Results A total of 53 patients with NVAF were enrolled.There was no significant difference about age,sex ratio,body mass index,alanine aminotransferase,creatinine clearance and coagulation index between the two groups(P>0.05).Compared with the routine group,the prolongation of the APTT and TT in pharmacy service group were more obvious,and the difference between two groups was statistically significant(P<0.05).There was no clinical events such as stroke,cerebral hemorrhage,embolism in other parts and death occurred during the follow-up period.The rate of ADR in pharmacy service group and routine group were 7.41%and 19.23%respectively,with no significant difference(P>0.05).Conclusion Integrated anticoagulant pharmaceutical care has good prospects,which can improve the understanding of anticoagulants for patients with NVAF,improve the anticoagulant effect and reduce the occurrence of adverse drug reactions.