心脑血管疾病患者围手术期抗栓药物治疗临床路径管理评价

Evaluation of clinical pathway management of antithrombotic drug therapy in perioperative period for patient with cardiovascular and cerebrovascular diseases

目的评价心脑血管疾病患者围手术期抗栓药物治疗临床路径管理的干预效果。方法将2019年10月—2020年9月、2020年10月—2021年9月在北京朝阳医院外科治疗的心脑血管疾病住院患者分为常规治疗组和药师干预组。药师依据临床路径对患者用药方案进行干预,并持续跟踪随访至患者出院。以围手术期抗栓药物使用适宜占比、药品不良事件发生率、住院天数、住院总费用、出院后3个月再入院发生率等为指标评价围手术期抗栓药物临床路径管理效果。结果常规治疗组121例,药师干预组202例,两组心脑血管事件(5.0%vs.5.0%)、静脉血栓栓塞症(2.5%vs.3.0%)、出血事件(3.3%vs.2.0%)的发生率差异均无统计学意义(P>0.05);药师干预组围手术期抗栓药物使用的各类适宜占比(术前抗血小板药物治疗61.9%vs.24.0%,术前抗凝药物治疗66.3%vs.39.7%,术后抗血小板药物治疗80.7%vs.10.0%,术后抗凝药物治疗89.6%vs.65.3%,P<0.001)、住院天数(13.00 d vs.10.00 d,P=0.004)、住院期西药费用(2692.97元vs.2110.76元,P=0.008)、住院期抗凝药物费用(406.20元vs.200.28元,P<0.001)均显著低于常规治疗组。结论心脑血管疾病患者围手术期抗栓药物治疗临床路径的建立及应用可能会改善心脑血管疾病患者围手术期抗栓药物使用不适宜情况,不增加药品不良事件发生率,且减轻了患者的经济负担。

Objective To investigate the intervention effect of clinical pharmacists using clinical pathway of antithrombotic drug therapy in the perioperative period for patients with cardiovascular and cerebrovascular diseases.Methods The surgical inpatients with cardiovascular and cerebrovascular diseases from October 2019 to September 2020 were the conventional therapy group,and the inpatients from October 2020 to September 2021were the pharmacist intervention group.The clinical pharmacists intervened the patients’medication regimen according to the clinical pathway,and continued to follow up until the patients were discharged from the hospital.The incidence of appropriate use of antithrombotic drugs during perioperative period,incidence of adverse durg events,length of hospital stays,readmission rate within 3 months after discharge,and total expenditure during hospitalization were compared and analyzed between the two groups of patients.Results 121 patients were included in the conventional therapy group,and 202 patients were included in the pharmacist intervention group.There were no significant differences in the incidence of cardiovascular and cerebrovascular events(5.0%vs.5.0%),venous thromboembolism(2.5%vs.3.0%)and bleeding events(3.3%vs.2.0%)between the two groups(P>0.05).The proportion of all kinds of appropriate use of antithrombotic drugs during perioperative period(preoperative antiplatelet therapy 61.9%vs.24.0%,preoperative anticoagulant therapy 66.3%vs.39.7%,postoperative antiplatelet therapy 80.7%vs.10.0%,postoperative anticoagulant therapy 89.6%vs.65.3%,P<0.001),duration of hospitalization(13.00 days vs.10.00 days,P=0.004),cost of western medicine during hospitalization(2692.97 yuan vs.2110.76 yuan,P=0.008),cost of anticoagulant drugs during hospitalization(406.20 yuan vs.200.28 yuan,P<0.001)in pharmacist intervention group were significantly lower than those in conventional therapy group.Conclusion The establishment and application of clinical pathway of antithrombotic therapy in the perioperative period for patients with cardiovascular and cerebrovascular diseases may significantly improve the inappropriate use of antithrombotic drugs during the perioperative period,and effectively alleviate the economic burden of patients without increasing the incidence of adverse events.