延伸性抗凝药学监护对房颤并PCI手术患者临床效应的影响

Clinical Influence of Extended Anticoagulant Pharmaceutical Care on Patients with Atrial Fibrillation Complicated with PCI Operation

目的:分析临床药师延伸性抗凝药学监护对房颤患者经皮冠状动脉介入术(Percutaneous coronary intervention,PCI)临床效应的影响。方法:选取本院2017年1月~2020年5月收治的150例房颤合并急性冠脉综合征患者,随机分为研究组和对照组,各75例,均给予PCI及抗血小板治疗。对照组接受抗凝药物常规使用指导;研究组接受延伸性抗凝药物使用监护。对比两组随访1年内全因死亡率,国际血栓形成与止血法学会(International Society on Thrombosis and Haemostasis,ISTH)大出血、临床相关非大出血(Clinically relevant non-major bleeding,CRNMB)、脑卒中、周围动脉栓塞、再发心肌梗死、支架内血栓发生率,以及随访期间再次住院时间。结果:研究组失访3例,对照组失访7例,其余140例均获得有效随访。研究组随访期间3例死亡,对照组随访期间4例死亡,研究组、对照组全因死亡率分别为4.17%、5.88%,组间比较差异无统计学意义(P>0.05)。随访期间研究组小出血发生率低于对照组,差异有统计学意义(P<0.05)。随访期间,两组在脑卒中、心肌梗死、支架内血栓、周围动脉栓塞发生率比较,差异无统计学意义(P>0.05)。随访期间研究组住院时间为(5.11±1.62)d,低于对照组的(8.07±1.95)d,差异有统计学意义(t=9.791,P<0.001)。随访期间,研究组华法林抗凝治疗达标率为68.75%,高于对照组的26.67%,差异有统计学意义(P<0.05)。结论:临床药师延伸性抗凝药物使用监护能够降低房颤患者PCI术后1年内小出血事件发生率、减少再住院时间、提高华法林抗凝的达标率。

Objective:To analyze the influence of extended anticoagulant pharmaceutical care on the clinical effects of patients with atrial fibrillation after percutaneous coronary intervention(PCI).Methods:A total of 150 patients with atrial fibrillation complicated with acute coronary syndrome in our hospital from January 2017 to May 2020 were randomly divided into study group or control group,with 75 cases in each group.All patients were treated with PCI and antiplatelet therapy.Patients of the control group received routine instruction for use of anticoagulants,while those of the study group received extended supervision on use of anticoagulants by clinical pharmacists.The incidences of all-cause mortality,international society on thrombosis and hemostasis(ISTH)massive hemorrhage,clinically relevant non-major bleeding(CRNMB),stroke,peripheral artery embolism,recurrent myocardial infarction and stent thrombosis,and the hospitalization time during follow-up were compared.Results:There were 3 cases lost in the study group and 7 cases lost in the control group.All the other 140 patients were followed up effectively for≥1 year.Three cases died in the study group and 4 cases died in the control group during the follow-up period.The all-cause mortality of the study group and the control group were 4.17%and 5.88%,respectively,(P>0.05).During the follow-up period,the incidence of minor bleeding in the study group was lower than that in the control group(P<0.05).During the follow-up period,there was no significant difference in the incidence of stroke,myocardial infarction,stent thrombosis and peripheral artery embolism between the two groups(P>0.05).During the follow-up period,the hospitalization time of the study group((5.11±1.62)days)was shorter than that of the control group((8.07±1.95)days)(t=9.791,P<0.001).During the follow-up period,the compliance rate of warfarin anticoagulation in the study group(68.75%)was higher than that(26.67%)in the control group(P<0.05).Conclusion:Clinical pharmacists'extended anticoagulation monitoring can reduce the incidence of minor bleeding events within one year after PCI,reduce the time of readmission and improve the compliance rate of warfarin anticoagulation therapy.