全程化药学监护对房颤患者抗凝治疗的影响

目的：评估临床药师通过实施全程化药学监护，参与房颤患者抗凝治疗管理的效果。方法：选取2016年5月-2017年7月于某院心血管内科病房住院且首次服用华法林抗凝的房颤患者共计101例为研究对象，按照随机数字表法分为对照组和干预组。对照组患者入院后给予常规抗凝治疗，由医生及护士实施抗凝治疗方案。干预组在对照组的基础上，由临床药师实施全程化药学监护。比较2组患者INR在目标范围时间的百分比（the percentage of INRs within the therapeutic range，TTR）、出院后不同时间段国际标准化比值（international normalized ratio，INR）达标率、出院后一年内不良事件发生率。结果：干预组的TTR为（50.23±20.71）%，高于对照组的（34.81±22.99）%，差异有显著性（P<0.05）。患者出院后3 d干预组INR达标率高于对照组，但差异无显著性（P>0.05），出院后5 d、7 d、14 d干预组的INR达标率均高于对照组，差异均有显著性（P均<0.05）。干预组不良事件的总发生率低于对照组（2% vs.7.84%），但差异无显著性（P>0.05）。结论：临床药师参与房颤患者抗凝治疗管理，可帮助患者加快INR达标速度，提高抗凝治疗质量，但仍需加强管理，使抗凝治疗更加安全、有效。

The effect of whole-course pharmaceutical monitoring on anticoagulant therapy in patients with atrial fibrillation

OBJECTIVE To evaluate the effect of clinical pharmacists in the management of anticoagulant therapy in patients with atrial fibrillation by implementing full-scale pharmaceutical monitoring.METHODS A total of 101 patients with atrial fibrillation who were hospitalized in the cardiovascular department of our hospital from May 2016 to July 2017 and who received warfarinfor anticoagulation for the first time were included in the study.The patients were divided into the control group and the intervention group according to the random number table method.The patients in the control group were given routine anticoagulant therapy after admission,and the anticoagulation regimen was implemented by doctors and nurses.On the basis of the control group,a full-time pharmacological monitoring was performed by clinical pharmacists.The percentage of INRs within the therapeutic range (TTR) of the two groups of patients,the international normalized ratio (INR) compliance rate of different time periods after discharge,and the incidence of adverse events within one year after discharge were compared.RESULTS The TTR of the intervention group was (50.23±20.71)%,which was higher than that of the control group (34.81±22.99)% with a significant difference (P<0.05).The INR compliance rate of the intervention group was higher than that of the control group at 3 days after discharge,but the difference was not significant (P>0.05).The INR compliance rate of the intervention group at 5 days,7 days and 14 days after discharge was higher than that of the control group,and the difference was statistically significant (P<0.05).The overall incidence of adverse events was lower in the intervention group than in the control group (2% vs.7.84%),but the difference was not significant (P>0.05).CONCLUSION S The participation of clinical pharmacists in the management of anticoagulation therapy in patients with atrial fibrillation can help patients to accelerate INR target rate and improve the quality of anticoagulation therapy,but it is still necessary to strengthen the management to make anticoagulation therapy more safe and effective..