131例口服抗血栓药物致不良反应的帕累托图分析和干预

Pareto diagram analysis and intervention of 131 cases of adverse drug reactions caused by oral antithrombotic drugs

目的基于医院口服抗血栓药物不良反应(ADR)报告数据,分析该类药物引起ADR的特性,为临床安全用药提供参考。方法对2020年1月至2022年6月上报国家药物ADR监测中心的131例口服抗血栓药ADR报告进行回顾性分类统计分析,绘制帕累托图。结果131例口服抗血栓药物的ADR报告中,新ADR报告1例(0.76%),严重ADR报告86例(65.65%);ADR上报以药师为主(93例,70.99%),2020~2022年医生上报比重逐年增高(2020年0,2021年4.84%,2022年63.64%);男性(75例,57.3%)多于女性(56例,42.7%),其中51~80岁人群占比最大;引发ADR的主要药品为阿司匹林(95例,64.63%),其次为氯吡格雷(22例,14.96%)和华法林(12例,8.16%);ADR临床表现以血液系统损害最为常见(111例,72.55%),消化道为主要出血部位(87例,78.37%)。结论口服抗血栓药物所致ADR与多种因素有关,临床用药应全面考虑ADR,重点关注主要药品,加强ADR监测;临床药师应协助医师采取积极有效干预措施,减少ADR发生,确保临床用药安全。

Objective To analyze the characteristics of adverse drug reactions(ADR)caused by oral antithrombotic drugs based on the statistics reported in our hospital,so as to provide references for clinical safe and rational use of drugs.Methods A total of 131 cases of ADR caused by oral antithrombotic drugs reported to National Center for ADR Monitoring,China from January 2020 to June 2022 in our hospital were analyzed retrospectively,and a Pareto diagram was drawn.Results Among 131 cases,1 case(0.76%)was newly reported ADR,and 86 cases(65.65%)were serious ADR.Among them,93 cases(70.99%)were reported by pharmacists,and the proportion of cases by doctors from 2020 to 2022 increased annually(2020,0%;2021,4.84%;2022,63.64%).The incidence of ADR was significantly higher in males(75 cases,57.3%)than in females(56 cases,42.7%),and the age group of 51-80 years accounted for the largest proportion.Aspirin(95 cases,64.63%)was the most commonly used antithrombotic drug,followed by clopidogrel(22 cases,14.96%)and warfarin(12 cases,8.16%).Blood system damage was the most common clinical manifestation of ADR(111 cases,72.55%),and digestive tract was the main bleeding site(87 cases,78.37%).Conclusion ADRs caused by oral antithrombotic drugs are related to a variety of factors.ADR should be considered comprehensively in clinical use,especially focusing on the commonly used drugs and monitoring of ADR.Active interventions should be made by a collaboration of both pharmacists and physicians,aiming to reduce the incidence of ADR and ensure the safety of medication.