586例住院膜性肾病患者抗凝预防现状的回顾性调查

Retrospective analysis of anticoagulation prophylaxis in 586 hospitalized patients with membranous nephropathy

目的:开展回顾性调查研究,分析住院膜性肾病患者相关静脉血栓的预防情况,探讨临床药学服务在膜性肾病患者静脉血栓栓塞症(venous thromboembolism,VTE)预防中应发挥的作用。方法:查阅武汉大学人民医院2020年5月至2022年5月住院的膜性肾病患者病历586份,分别采用Caprini及Padua栓塞评分评估患者VTE风险,并对VTE预防抗凝率、抗凝药物选用及膜性肾病VTE发生情况等进行统计分析。结果:经评估Caprini评分≥3分的215例高风险患者中,使用抗凝药物的患者有127例(59.07%),预防用抗凝药物使用率为57.21%;Padua≥4分的26例高危患者中,使用抗凝药物的患者有22例(84.61%),预防用抗凝药物使用率为73.08%;5例患者住院期间发生VTE,其中1例存在抗凝相对禁忌(尿潜血)未予抗栓治疗。膜性肾病VTE预防主要选用指南推荐的低分子肝素、华法林、新型口服抗凝药等抗凝药物,抗凝药物选用总体较为合理。结论:该院住院膜性肾病患者静脉血栓的预防尚存在不足,提示临床药师应针对问题开展相应的学习及宣教,积极参与膜性肾病患者静脉血栓的预防及管理,提高膜性肾病患者生活质量,改善生存预后。

OBJECTIVE The venous thrombosis(VTE)prophylaxis in hospitalized membranous nephropathy was investigated retrospectively,and the possible clinical pharmaceutical care to promote VTE prophylaxis was discussed.METHODS A total of 586 patients with membranous nephropathy hospitalized from May 2020 to May 2022 were involved.Medical records were reviewed to statistically assess the VTE risk and the prophylaxis options in anticoagulants.RESULTS A total of 215 patients were at high risk of VTE with a Caprini risk score≥3,127 patients(59.07%)were given anticoagulants and 57.21%for preventive anticoagulants.A total of 26 patients were at high risk of VTE with a Padua risk score≥4,22 patients(84.61%)were given anticoagulants and 73.08%for preventive anticoagulants.5 patients developed VTE during hospitalization,and 1 patient had anticoagulant relative contraindication(urinary occult blood)without antithrombotic therapy.Low molecular weight heparin,warfarin,and new oral anticoagulants were the anticoagulants used in VTE prophylaxis in this study,which follows the recommendation of clinic guidelines.CONCLUSION Venous thromboembolism prophylaxis in membranous nephropathy requires more attention.Pharmaceutical care,such as education and risk management,may help to improve the quality of life and prognosis in patients with membranous nephropathy.It is suggested that clinical pharmacists should carry out corresponding learning and education according to the problems,actively participate in the prevention and management of venous thrombosis in patients with membranous nephropathy.