充分发挥药师在直接口服抗凝药用药安全管理中的作用

Give full play to the role of pharmacists in the safety management of direct oral anticoagulants

国内外相关指南推荐直接口服抗凝药(DOAC)作为心房颤动和静脉血栓栓塞性疾病抗凝治疗的一线药物。与华法林相比,DOAC剂量相对固定,药物相互作用有限,不需要治疗药物监测。但DOAC给抗凝治疗带来方便的同时,也带来一系列新的用药安全挑战。药师应通过完善相应药学服务机制如协助医师确保DOAC处方适宜性、规范实验室监测流程、设置潜在药物相互作用预警以及加强抗凝药物转换和围术期抗凝治疗的管理等多种途径,为DOAC的安全使用保驾护航。在新型冠状病毒肺炎后疫情时代,将DOAC纳入抗凝门诊的规范化管理是传统抗凝门诊工作的重要拓展,可降低患者暴露于新型冠状病毒的风险。此外,临床药师人力和精力通常受限,DOAC相关临床决策支持系统的应用有助于改善处方的适宜性和减少药物不良事件的发生。

Direct oral anticoagulants(DOACs)are recommended as first-line therapy in patients with atrial fibrillation and venous thromboembolic diseases in relevant guidelines at home and abroad.Compared with warfarin,DOACs have relatively fixed dose,fewer drug interactions,and no need of routine therapeutic drug monitoring in clinic.DOACs bring much convenience to anticoagulant therapy,but they also raise a series of new medication safety challenges.Pharmacists should ensure the safe use of DOAC through improving corresponding pharmaceutical care mechanism,such as assisting doctors to improve the suitability of dose in prescription,standardizing laboratory monitoring process,setting up early warning of potential drug interaction,and strengthening anticoagulant conversion and perioperative anticoagulant therapy management.In the post-coronavirus disease 2019 era,incorporating DOACs into the standardized management at anticoagulation clinics is an important work extension of the traditional anticoagulation clinics and may reduce the risk of exposure to the novel coronavirus.In addition,considering the limit in labour and work energy of clinical pharmacists,the application of DOAC-related clinical decision support system may help improve the appropriateness of prescription and reduce the adverse drug events.