目的 以高警示药物中非维生素K拮抗口服抗凝药物(non-vitamin K oral anticoagulants,NOACs)为例,阐述如何从药学角度出发,协助临床医师为房颤(atrial fibrillation,AF)患者决策出合适的药物种类和剂量。方法 基于临床药师实践经验、药品说明书、临床指南,以及超说明书情况下的循证医学证据,制订出NOACs用药指征判断和剂量决策流程图。结果 目前指南推荐非瓣膜性房颤患者首选NOAC预防卒中和体循环栓塞,采用流程化的思维方式选择恰当的NOACs和剂量,能够提高AF抗凝决策水平和效率,促进NOACs在不同地区和中心同质化地合理使用。结论 药学思维应当侧重于用药安全的建设,药师在抗凝治疗实践中,应当平衡患者的血栓及出血风险,提供个体化用药方案,协助医生抗凝药物决策,并为患者做好用药教育工作,保证药物的疗效、安全性和依从性。
Abstract
To assist clinicians in making decisions on the appropriate drug kinds and dosages in patients with atrial fibrillation(AF) from the perspective of pharmacy, non-vitamin K oral anticoagulants(NOACs) in the list of China′s List of High Alert Drugs list will be described as a case for reference. METHODS The flow chart of indication judgment and dosage decision of NOACs was developed based on the practical experience, drug labels, clinical guidelines, and evidence for off-label use according to the evidence-based medicine. RESULTS Currently, NOACs are recommended as the first choice for patients with non-valvular atrial fibrillation(NVAF) to prevent stroke and systemic embolism. Using a process thinking to select the appropriate NOACs and doses, the level and efficiency of AF anticoagulation decision-making can be improved,and the rational use of NOACs in different regions and centers can be promoted. CONCLUSION Pharmacy thinking should be focused on the construction of safety culture.In anticoagulant treatment decision-making practice, pharmacists should provide individualized regimens after balancing the thrombosis and bleeding risks of patients, and assist clinicians in making decisions about anticoagulants. In addition, education should be carried out for patients to ensure the efficacy, safety and compliance of medication.
关键词
房颤 /
非维生素K拮抗口服抗凝药物 /
药学思维
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Key words
atrial fibrillation /
non-vitamin K oral anticoagulant /
pharmaceutical thinking
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中图分类号：
R969.3
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参考文献
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脚注
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基金
北京医卫健康公益基金会医学科学研究基金资助(YWJKJJHKYJJ-B17248-047)
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