住院患者艾多沙班临床应用调查分析

Investigation and analysis of clinical application of edoxaban in hospitalized patients

目的:探索住院患者使用艾多沙班进行抗凝治疗的情况,为规范其临床合理使用提供依据。方法:汇总国内外艾多沙班的相关指南、共识以及权威文献,并结合药品说明书形成艾多沙班临床应用评价标准(以下简称“标准”),同时回顾性收集2021年度入住河南省人民医院(下称“我院”)使用艾多沙班的患者病例,按照评价标准对其适应证、用法用量、给药时机、相互作用等进行分析。结果:对最终纳入的16篇文献进行汇总,形成“标准”。212份病例中,将近一半(98/212,46.2%)的患者可能存在用药不合理现象,按实际发生频数进行统计,包括不适宜的超适应证用药41次(19.3%),用药时机不合理5次(2.4%),给药剂量不合理42次(19.8%),禁忌证用药6次(2.8%),以及联合用药存在禁忌5次(2.4%)。结论:我院住院患者艾多沙班的临床应用与“标准”仍存在一定差距,主要集中在不适宜的超适应证用药和给药剂量不适宜。药师应及时关注艾多沙班临床指南和相关循证学证据的更新,积极参与该类患者的药物管理,促进艾多沙班的临床合理使用。

OBJECTIVE To explore edoxaban use for anticoagulationin in hospitalized patients, so as to provide support for standardizing clinical use.METHODS To summarize the guidelines, consensus, authoritative references and package insert of edoxaban at domestic and foreign, develop the evaluation criteria for the clinical application of edoxaban(hereinafter referred to as “criteria”).At the same time, we retrospectively collected the medical records of patients who were admitted to Henan Provincial People’s Hospital and were prescribed edoxaban in 2021,criteria was performed on indications, usage and dosage, time of administration, interactions.RESULTS 16 literatures were finally summarized to form the “criteria”.Among the 212 medical records, nearly half(98/212,46.2%)patients accepted inappropriate edoxaban treatment.According to the actual frequency of the occurrence, including 41 times of unreasonable off-label(19.3%),5 times of unreasonable administration timing(2.4%),42 times of unreasonable doses(19.8%),6 times of contraindications(2.8%),and 5 times of contraindications with combined medications(2.4%).CONCLUSIONS There still exists a certain gap between the current use and the “criteria” for edoxaban in hospitalized patients.The irrational use mainly focused on the inappropriate indications and inappropriate doses.Pharmacists should pay attention to the update of clinical guidelines and relevant evidence-based medicine for edoxaban, and communicate with clinicians timely to promote rational application of edoxaban.