直接口服抗凝药合理用药和处方质量评价药学建议

Pharmaceutical Recommendation on Rational Use and the Prescription Quality Evaluation of Direct Oral Anticoagulants

传统口服抗凝药华法林治疗窗窄,剂量个体差异大,受众多药物、饮食相互作用的影响,需要频繁监测国际标准化比值来监测药物的疗效和安全性。直接口服抗凝药(DOAC)由于不需要常规监测凝血功能、饮食顾虑较少、使用便捷,其处方量迅速增长。尽管DOAC治疗有诸多优势,其管理过程中仍存在新的挑战,包括处方的不适宜性、药物依从性的要求、潜在的药物相互作用和缺乏特异性监测指标等。由于口服抗凝药有高风险特性,因此需要通过规范化管理来提升其用药安全。本药学建议的目的是为医师和药师提供DOAC的规范化管理措施和处方审核标准,以期建立DOAC相关的用药安全文化。

The traditional oral anticoagulant warfarin has a narrow therapeutic window,large individual dose variation,and is affected by many drug and dietary interactions,so it is necessary to monitor the international normalized ratio(INR)value frequently to monitor the efficacy and safety of the drug.Prescriptions for direct oral anticoagulant(DOAC)have increased rapidly because they do not require routine monitoring of coagulation function,have fewer dietary concerns,and are easy to use.Despite the many advantages of DOAC therapy,new challenges remain in the management of DOAC,including prescription inappropriateness,medication adherence requirements,potential drug interactions,and lack of specific monitoring indicators.Due to the high-risk nature of oral anticoagulants,it is necessary to improve drug safety through standardized management.The purpose of this recommendation is to provide standardized DOAC management measures and prescription review standards for physicians and pharmacists to establish DOAC-related medication safety culture.