利伐沙班在非瓣膜性房颤患者中的临床应用分析及建议

Analysis and suggestion of rivaroxaban in patients with non-valvular atrial fibrillation

目的:制定利伐沙班在临床非瓣膜性房颤患者中应用的合理性评价标准和用药建议,为规范其临床合理应用提供依据。方法:汇总国内外利伐沙班相关指南、专家共识和文献,形成利伐沙班在非瓣膜性房颤患者中应用的合理性评价标准,回顾性调查某院2018年下半年非瓣膜性房颤住院患者中使用利伐沙班病例,通过纳入标准,将符合要求的病例按照评价标准进行合理性分析;通过发放调查问卷汇总医生和患者在使用利伐沙班过程中的关注点,针对性制定合理化用药建议。结果:2018年下半年,利伐沙班在非瓣膜性房颤住院患者中使用例数共计217例,实际统计分析病例106例,利伐沙班使用不合理率为19.81%(21/106),以低剂量人群和特殊病理状态患者给药剂量和围手术期用药时机错误为主要原因,不良反应发生率为6.60%(7/106),均为出血性不良反应;医生和患者在使用利伐沙班中的关注点多集中在监护指标、出血事件处理和用药注意事项等方面。结论:利伐沙班在临床非瓣膜性房颤患者中应用较广泛,其疗效良好,但仍然存在不合理用药情况,特别是在给药剂量和围手术期用药方面,临床药师应密切关注利伐沙班临床应用指南等的更新,制定合理性评价标准和用药建议,积极与医生和患者沟通,促进利伐沙班合理使用。

OBJECTIVE To establish the rationality evaluation criteria and medication recommendations for the application of rivaroxaban in patients with non-valvular atrial fibrillation,and to provide a basis for regulating its rational clinical application.METHODS The relevant guidelines,expert consensus and literatures of rivaroxaban at home and abroad were summarized to form the rationality evaluation criteria for the application of rivaroxaban in patients with non-valvular atrial fibrillation.The cases of rivaroxaban in hospitalized patients with non-valvular atrial fibrillation in a hospital in the second half of 2018 were retrospectively investigated.Through the inclusion criteria,the qualified cases were analyzed for rationality according to the evaluation criteria;a questionnaire was distributed to summarize the concerns of doctors and patients in the process of using rivaroxaban,and reasonable medication recommendations were targeted.RESULTS In the second half of 2018,217 patients with non-valvular atrial fibrillation were treated with rivaroxaban,106 patients were analyzed statistically,and 19.81%(21/106)of rivaroxaban was irrational.The main reasons were wrong dosage and perioperative medication timing in patients with low-dose population and special pathological conditions,the incidence of adverse reactions was 6.60%(7/106),all of which were hemorrhagic adverse reactions;the attention of doctors and patients in the use of rivaroxaban mostly focused on monitoring indicators,bleeding event treatment and medication precautions.CONCLUSION Rivaroxaban is widely used in patients with non-valvular atrial fibrillation,and has good curative effects,but there are irrational usage,especially in terms of dose and perioperative drug usage.Clinical pharmacists should pay active attention to the update of the clinical application guidelines for drugs,establish the rationality evaluation standard and medication recommendations,and actively communicate with doctors and patients to jointly promote the rational use of rivaroxaban.