骨科那屈肝素药物利用评价标准的建立与应用

Establishment and Application of Drug Use Evaluation Criteria of Nadroparin in Orthopedics

目的:建立骨科那屈肝素药物利用评价(DUE)标准,并对其临床使用情况进行评价,为骨科合理使用那屈肝素提供参考。方法:以那屈肝素的药品说明书为基础,参考相关指南和文献,通过专家咨询法制订那屈肝素DUE标准,并采用回顾性分析法,对2021年9月至2022年4月厦门大学附属东南医院骨科病区使用那屈肝素的住院患者进行用药合理性评价。结果:共纳入439例使用那屈肝素的住院患者,用药指征总体符合率为91.12%(400例),给药途径、配伍禁忌符合率为100%(439例)。373例使用那屈肝素预防静脉血栓栓塞症且符合用药指征的患者中,给药剂量和给药频次符合率为21.98%(82例);61例使用那屈肝素治疗深静脉血栓形成的患者中,给药剂量和给药频次符合率为13.11%(8例);402例具有用药指征的患者中,首次给药时机总体符合标准率为70.40%(283例);171例术前抗凝患者中,围手术期停药时机符合标准率为97.08%(166例);402例术后抗凝患者中,重启时机符合标准率为98.26%(395例);93例存在那屈肝素与其他抗凝血药相互转换的患者中,药物转换总体符合标准率为95.70%(89例)。结论:应用建立的那屈肝素DUE标准进行回顾性分析,发现骨科应用那屈肝素治疗过程中存在给药剂量和频次不合理、首次给药时机不适宜、用药监护不到位等问题,可为进一步促进临床合理用药提供参考。

OBJECTIVE:To establish the drug use evaluation(DUE)criteria of nadroparin in orthopedics,and to evaluate the clinical use of nadroparin,so as to provide reference for rational use of nadroparin in orthopedics.METHODS:Based on the drug description of nadroparin and referring to relevant guidelines and literature,the DUE criteria of nadroparin was established by expert consultation method.Retrospective analysis was conducted to evaluate the application rationality of nadroparin in the orthopedic inpatients of Dongnan Hospital of Xiamen University from Sept.2021 to Apr.2022.RESULTS:A total of 439 inpatients with nadroparin were included,the overall compliance rate of medication indications was 91.12%(400 cases);the rate of route of administration and incompatibility meeting the criteria was 100%(439 cases).Of the 373 patients with nadroparin in preventing venous thromboembolism and met the medication indications,the rate of drug dosage and frequency meeting the criteria was 21.98%(82 cases).Of the 61 patients with nadroparin in the treatment of deep venous thrombosis,the rate of drug dosage and frequency meeting the criteria was 13.11%(8 cases).Of the 402 patients with medication indications,the overall compliance rate of the first medication time was 70.40%(283 cases).Of the 171 patients with preoperative anticoagulation,97.08%(166 cases)met the criteria for the timing of drug discontinuation during the perioperative period.Of the 402 patients with postoperative anticoagulation,98.26%(395 cases)met the criteria for restart timing.Among the 93 patients with conversion of nadroparin to other anticoagulants,the overall compliance rate of drug conversion was 95.70%(89 cases).CONCLUSIONS:The established DUE criteria of nadroparin is used for retrospective analysis to find out that there are some problems in the treatment of orthopaedic patients with nadroparin,such as irrational dosage and frequency,inappropriate time of first medication,and insufficient monitoring of medication,which provides reference for further promoting rational clinical drug use.