临床药师参与房颤患者华法林抗凝管理的效果评价

目的探讨临床药师参与房颤患者华法林抗凝管理的成效。方法收集2016年6月至2018年6月被心血管科收治,且明确诊断为非瓣膜房颤患者,使用华法林抗凝治疗的180例患者,将其随机分为临床药师管理的干预组86例和传统抗凝管理的对照组94例,进行抗凝管理的评价分析。结果患者首次国际标准化比值(INR)达标率干预组为89.5%,对照组为86.2%,P>0.05。干预组与对照组末次INR达标率分别为68.6%和52.1%,人均达标次数分别为9.97±3.02和6.05±4.02,治疗窗内时间(TTR)分别为(68.47±11.66)%和(55.82±17.60)%,干预组明显优于对照组,P<0.05。干预组与对照组发生栓塞事件分别有11例与16例,差异无统计学意义;发生的出血事件分别为4例与8例,差异无统计学意义。干预组INR≥5的例数为3例,对照组12例,P<0.05。干预组依从性低的患者比例为0,依从性高的患者比例为52.32%;对照组依从性低的患者比例为9.57%,依从性高的患者比例为26.60%。干预组患者依从性优于对照组,差异有统计学意义。结论临床药师参与华法林抗凝治疗可提高后期INR达标率、达标次数及TTR,改善患者依从性,有助于提升华法林治疗的有效性和安全性。

Evaluation of warfarin anticoagulant management by clinical pharmacists on patients with atrial fibrillation

AIM To explore the effect of clinical pharmacists on the anticoagulation management of warfarin in patients with atrial fibrillation.METHODS For patients with non-valvular atrial fibrillation who were admitted to the Department of Cardiology from June 2016 to June 2018,180 patients who were treated with warfarin anticoagulation were randomly divided into the intervention group(86 patients)and the control group(94 patients),and the evaluation of anticoagulation management was carried out.RESULTS The first international standard ratio(INR)compliance rate was 89.5%in the intervention group and 86.2%in the control group,P>0.05.The last INR compliance rates of the intervention group and the control group were 68.6%and 52.1%respectively.The per capita compliance times were 9.97±3.02 and 6.05±4.02 respectively,and the time in therapeutic range(TTR)were(68.47±11.66)%and(55.82±17.60)%respectively.The last INR compliance rate,per capita compliance times and TTR had significant difference between the 2 groups,P<0.05.Embolism and bleeding events(11 and 4 patients,respectively)in the intervention group were less than those in the control group(16 and 8 patients),but the difference was not statistically significant.The number of cases with INR≥5 in the intervention group was 3,which was less than 12 in the control group,P<0.05.In the intervention group,the proportion of patients was 0 with low compliance,and that was 52.32%with high compliance.In the control group,9.57%of patients had low compliance,and 26.60%patients had high compliance.Compared with patients in the control group,those in the intervention group had relatively better medication adherence.CONCLUSION The participation of clinical pharmacists in warfarin anticoagulant therapy can improve the INR compliance rate,the number of compliance and TTR,improve patient compliance,and improve the effectiveness and safety of warfarin therapy.