药学干预对缺血性脑卒中合并房颤患者抗凝诊疗管理的影响

Influence of Pharmaceutical Intervention on the Managements of Anticoagulation Therapy in Patients with Ischemic Stroke Complicated with Atrial Fibrillation

目的:观察药学干预对缺血性脑卒中合并心房颤动患者抗凝诊疗管理的影响。方法:前瞻性纳入武汉市第三医院神经内科2019年1~12月收治的急性缺血性脑卒中合并房颤患者,对照组患者接受常规诊疗,干预组在常规诊疗基础上接受全程药学干预。观察比较两组患者的基本特征、抗凝治疗率、用药依从性、不良事件。结果:干预组抗凝治疗率显著性高于对照组(60.0%vs.40.2%,P<0.05);干预组例均费用和药占比分别为5 743.6元和37.5%,较对照组显著降低(P<0.05)。平均随访(10.2±3.2)个月,干预组患者高依从性比例显著高于对照组(71.2%vs.55.4%,P<0.05);总出血事件发生率显著低于对照组(8.0%vs.19.3%,P<0.05)。两组患者缺血事件、死亡及大出血事件差异无统计学意义(P>0.05)。结论:急性缺血性脑卒中合并房颤患者死亡、血栓及出血风险均较高,积极的药学干预可提高患者抗凝治疗率和用药依从性,降低例均药费、药占比及出血事件的发生。

Objective: To explore the safety and efficacy of pharmaceutical intervention in the treatment of anticoagulation of patients with acute ischemic stroke(AIS) and atrial fibrillation(AF). Methods: Single-center cases of patients with AIS and AF at Wuhan Third Hospital from January 2019 to December 2019 were enrolled prospectively. Patients in the intervention group received pharmaceutical intervention plus routine treatment, while patients in the control group received routine treatment. The clinical characteristics, anticoagulant therapy, embolization and bleeding events were summarized.Results: The rates of anticoagulant therapy(60.0% vs.40.2%) and antiplatelet therapy(30.0% vs.47.6%) in the intervention group were statistically different from those in the control group(P<0.05). The average drug cost and drug proportion of the intervention group were lower than those of the control group(P<0.05). After follow-ups for(10.2±3.2) months, the proportion of patients with high adherence was significantly higher in the intervention group than that in the control group(71.2% vs.55.4%, P<0.05). Bleeding events in the intervention group were significantly lower than those in the control group(P<0.05). There were no significant differences in embolism, death and major bleeding between the two groups(P>0.05). Conclusion: Patients with AIS and AF are at high risk of death, thrombosis and hemorrhage. Active pharmaceutical intervention can improve the rate of anticoagulation therapy and medication adherence, and reduce the average drug cost, drug proportion and occurrence of embolism and bleeding events.