达比加群酯抗凝治疗合理性和安全性评价

Rationality and safety evaluation of dabigatran etexilate

目的:调查住院患者接受达比加群酯治疗情况,了解该药的应用现状和不良反应并分析其危险因素,为临床更好的使用达比加群酯提供参考依据。方法:收集中日友好医院2017年4月1日至2018年3月31日住院期间使用达比加群的患者信息,进行回顾性分析。通过分析患者适应证、肝肾情况、凝血指标、不良反应、药物转换及合并用药情况,评价达比加群酯使用的合理性和安全性。结果:共收集患者247例,其中男139例(56.28%),女108例(43.72%)。年龄29~91岁,平均(72.11±29.26)岁。使用达比加群的患者中老年人有207例(83.80%),因房颤及房扑入院的患者有184例(74.49%),占比最大。患者因CrCL<30 mL·min-1禁忌使用达比加群的情况下仍使用的有10例(4.05%)。19例(7.69%)患者住院期间使用达比加群出现不良反应,出血有14例(73.68%)。服用达比加群期间进行药物转换的患者32例(12.96%)。由华法林向达比加群转换22例(68.75%),使用错误率为36.36%。由达比加群向华法林转换6例(18.75%),使用错误率为100%。合用药物中联合使用抗血小板药37例(14.98%),联合使用胺碘酮16例(6.48%),临床使用期间应该加强监测。结论:达比加群临床常用于老年非瓣膜性房颤患者,使用前应注意肝肾功能监测,常见不良反应为出血,合并使用抗血小板药和胺碘酮时多注意监护。达比加群与华法林药物转换时错误较多,是药学监护的重点。

OBJECTIVE To investigate the treatment of dabigatran etexilate in hospitalized patients, to understand the status quo and adverse reactions of the drug and analyze its risk factors, so as to provide reference for the better clinical use of dabigatran etexilate. METHODS The information of patients who used dabigatran during hospitalization from April 1,2017 to March 31, 2018 in China-Japan Friendship Hospital was collected for retrospective analysis.The rationality and safety of dabigatran etexilate were evaluated by analyzing patient indications, liver and kidney conditions, coagulation parameters, adverse reactions, drug conversion and combined medication. RESULTS A total of 247 patients were enrolled, 139(56.28%) males and 108(43.72%)females. The age ranged from 29 to 91 years old, with an average of(72.11±29.26) years old. Among middle-aged and elderly population, 207 patients(83.80%) used dabigatran, and 184 patients(74.49%) were hospitalized due to atrial fibrillation and atrial flutter, accounting for the largest proportion..10(4.05%) patients remained on dabigatran under CrCL<30 mL·min-1which prohibited its use. 19(7.69%) patients had adverse reactions with dabigatran during hospitalization and 14(73.68%) patients had bleeding. During the treatment with dabigatran, 32(12.96%) patients switched to other medications.There were 22(68.75%) patients who discontinued warfarin and switched to dabigatran, and the error rate was 36.36%. There were 6(18.75%) patients who discontinued dabigatran and used warfarin, and the error rate was 100%.37(14.98%) patients was given dabigatran combined with antiplatelet agents, and 16(6.48%) was given dabigatran combined with amiodarone. Monitoring should be strengthened in clinical practice. CONCLUSION Dabigatran is commonly used in elderly patients with non-valvular atrial fibrillation. Liver and kidney function needs to be checked before using dabigatran. A common side effect of dabigatran is bleeding. More attention should be paid to monitoring when antiplatelet drugs and amiodarone are used in combination.More errors occurs when switching from warfarin, which should be the focus of pharmaceutical care.