基于Granada-Ⅱ分类法评价临床应用华法林的药物相关问题

Evaluation of drug related problems in clinical application of warfarin based on Granada Ⅱ classification

目的 探讨华法林在住院患者临床使用中的药物相关问题(drug-related problems, DRPs),促进华法林在住院患者中的合理使用。方法 采用回顾性调查的方法,从HIS系统抽取上海市嘉定区中医医院2020年5月到2021年6月住院期间使用华法林的所有病史。以华法林临床使用专家共识及指南、药品说明书等作为评价标准,采用Granada-Ⅱ分类法对住院患者期间使用华法林的必要性(DRP1、DRP2)、有效性(DRP3、DRP4)及安全性(DRP5、DRP6)进行评价。结果 此次共抽取到170份病例使用华法林,共有128例(75.29%)发生了DRPs,累计发生DRPs 276次,其中DRP486次(31.16%),DRP5177次(9.78%),DRP613次(59.06%)。结论 本院住院患者使用华法林的主要问题为安全性,其次为有效性,主要表现为药品不良反应及药物相互作用,抗凝专业临床药师需加强对住院患者华法林临床用药的干预,确保患者用药安全、有效。

Objective To explore the drug-related problems(DRPs) of warfarin in the clinical use of inpatients and promote the rational use of warfarin in inpatients.Methods All cases of warfarin use in our hospital from May 2020 to June 2021 were selected from his system by retrospective investigation. Taking the expert consensus and guidelines for the clinical use of warfarin and the drug instructions as the evaluation criteria, the necessity(DRP1, DRP2), effectiveness(DRP3, DRP4) and safety(DRP5, DRP6) of warfarin during hospitalization were evaluated by Granada Ⅱ Classification.Results A total of 170 cases were selected to use warfarin.A total of 128 cases(75.29%) had DRPs, with a total of 276 times, including 86 times of DRP4(31.16%), 177 times of DRP5(9.78%) and 13 times of DRP6(59.06%).Conclusion The main problem of warfarin use in hospitalized patients in our hospital is safety, followed by effectiveness, mainly manifested in adverse drug reactions and drug interactions.Clinical pharmacists majoring in anticoagulation need to strengthen the intervention of warfarin clinical use in hospitalized patients to ensure the safety and effectiveness of warfarin use.