临床药师抗凝管理工作模式探讨

Work mode of clinical pharmacists in anticoagulation management

目的 分析本院心血管科住院患者华法林应用情况,探讨临床药师抗凝管理的工作模式。方法 对北京同仁医院心血管病房2017年4月至2018年1月就诊的89例服用华法林的患者进行用药教育以及随访,包括适应证、华法林剂量、国际标准化比值(INR)、合并用药、不良反应等。结果 华法林主要用于房颤,住院患者使用华法林日剂量范围为0.75~6.00mg,日剂量(2.70±0.98)mg;INR波动范围为0.88~5.76,TTR范围为12.50%~92.31%,TTR为(59.23±19.70)%;不良反应发生率为8.98%;药师随访3个月后,患者对于药品掌握程度较住院时提高[(2.52±0.64)分比(0.58±0.72)分],差异有统计学意义(P<0.01),停药率较入院前降低(4.49%比30.56%),P<0.01。结论 临床药师抗凝管理模式可有效提高患者用药依从性及抗凝质量。

Objective To analyze the clinical application of warfarin and explore the work mode of clinical pharmacists in anticoagulation management.Methods 89 patients treated at the cardiovascular ward in our hospital from April,2014 to January,2018 were followed up and given medication education after discharge,including the indications,warfarin dosage,international normalized ratio(INR)、combined medicines,adverse reactions,and so on.Results The common indication of warfarin was atrial fibrillation.The dosage range of warfarin was 0.75-6.00 mg for hospitalized patients,and the average daily dose was(2.70±0.98)mg.INR fluctuated between 0.88 and 5.76.The time in therapeutic range(TTR)was from 12.50%to 92.31%,and the average was(59.23±19.70)%.The incidence of adverse reactions was 8.98%.The awareness score of the agents after 3 months’follow-up was superior to that before[(2.52±0.64)vs.(0.58±0.72),P<0.01]and the default rate was lower than that before(4.49%vs.30.56%,P<0.01).Conclusion Pharmacist anticoagulation management mode can improve the medicine compliance and the quality of anticoagulant therapy.