目的 探索抗凝门诊人工瓣膜术后患者华法林的使用情况,为真实世界临床实践提供指导。方法 对于2014~2019年抗凝门诊接受华法林治疗的人工瓣膜术后患者的情况进行回顾性分析。结果 接诊的人工瓣膜术后患者1 878人,总接诊次数4 423人次,其中75.3%的患者接受了人工机械瓣膜置换术;INR在治疗目标范围内的例次最多(46%),其次为INR＜1.8的情况(37%),平均TTR为(56.6±22.9)%;导致INR危急值的主要原因是药物相互作用、初始阶段调整华法林剂量、华法林敏感型患者,与华法林发生相互作用的药物主要是胺碘酮、苯溴马隆和抗菌药物;接诊患者共发生106例次出血事件,其中小出血占所有出血事件的90.6%。结论 人工瓣膜术后华法林抗凝治疗质量不良,小出血事件较多,药师应在患者住院和门诊就诊期间为患者反复教育抗凝治疗的必要性和严格遵循依从性的重要性。
Abstract
OBJECTIVE To explore the use of warfarin in patients with prosthetic heart valves in an anticoagulation clinic, and to provide guidance for clinical practice in real world setting. METHODS The data of patients onwarfarin with prosthetic heart valves were reviewed retrospectively in the anticoagulant clinic from 2014 to 2019. RESULTS In total, 1 878 patients were enrolled in the study, with a total number of 4 423 visits, of whom 75.3% received mechanical heart valve replacement. INR in the therapeutic range were the most cases(46%), the second is INR＜1.8(37%) and the average TTR was (56.6±22.9)%. The main reasons leading to the critical value of INR were drug interaction, initial adjustment of warfarin dose and warfarin-sensitive patients. The drugs that interact with warfarin are mainly amiodarone, benzbromarone and antibiotics.A total of 106 cases of bleeding events occurred, among which minor bleeding accounted for 90.6% of all bleeding events. CONCLUSION The quality of warfarin anticoagulant therapy in patients with prosthetic heart valves is poor, and minor bleeding events were quite common. Therefore, pharmacists should educate patients about the necessity of anticoagulant therapy and the importance of strict compliance during hospitalization and clinic visits.
关键词
人工瓣膜术后 /
华法林 /
抗凝门诊
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Key words
prosthetic heart valves /
warfarin /
anticoagulantion clinic
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中图分类号：
R969.3
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参考文献
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