住院患者达比加群酯的临床应用调查与分析

目的: 调查并分析苏州大学附属第一医院(以下称"我院")达比加群酯的使用现状,为规范其临床应用提供依据。方法: 汇总国内外达比加群酯的相关指南和专家共识及建议并结合药品说明书形成其临床应用合理性评价标准(以下简称"标准"),同时回顾性收集2020年度入住我院并使用达比加群酯的患者资料,对其适应证、禁忌证、用法用量、药物相互作用、桥接转换及围手术期使用等情况进行统计分析。结果: 共检索到文献978篇,最终纳入11篇形成"标准"。213例使用达比加群的患者中有56例(26.29%)存在用药不合理现象,其中无适应证用药3例(1.41%),禁忌证用药1例(0.47%),用法用量不合理19例(8.92%),桥接转换不合理4例(1.88%),存在不良药物相互作用1例(1.08%),围手术期用药不合理28例(13.15%)。结论: 我院住院患者达比加群酯的临床应用与"标准"仍存在一定差距,且不同科室间存在明显的差异,尤以给药频次和围手术期用药不合理最为突出。药师应及时关注达比加群酯及血栓栓塞性疾病相关循证医学证据的更新,同时积极参与全院患者的抗凝药物管理,进一步规范达比加群酯的临床应用。

Investigation and analysis of clinical application of dabigatran etexilateto inpatients

OBJECTIVE To investigate and analyze the clinical application of dabigatran etexilate in First Affiliated Hospital of Soochow University (hereinafter referred to as our hospital), so as to provide basis for regulating its clinical application. METHODS A summary of guidelines, consensus and recommendation at home and abroad combined with drug instruction was made to form the clinical rationality evaluation criteria for dabigatran etexilate (hereinafter referred to as criteria). Clinical data of inpatients treated with dabigatran etexilate in our hospital from January 2020 to December 2020 were retrospectively extracted. Statistical analysis was performed on indications, contraindications, usage and dosage, drug combination, drug conversion and perioperative drug usage. RESULTS A total of 978 literature were retrieved, and among them, 11 were finally included to form the criteria. Among the 213 patients, 56 cases (26.29%) had irrational use, including 3 cases (1.41%) with no indication, one case (0.47%) with contraindication, 19 cases (8.92%) with unreasonable usage and dosage, 4 cases (1.88%) with unreasonable bridge conversion, one case (1.08%) with adverse drug interaction and 28 cases (13.15%) with irrational drug use during perioperative treatment. CONCLUSION There is still a certain gap between the clinical application of dabigatran etexilate and the criteria, and there are obvious differences among different departments, especially in terms of frequency and perioperative drug usage. Pharmacists should pay active attention to the update of evidence-based medical evidence related to dabigatran etexilate and thrombosis diseases, and participate in the management of anticoagulant drugs to further standardize the clinical application of dabigatran etexilate.