2021 年第 2 期 第 16 卷

抗凝药物治疗管理门诊对华法林抗凝效果影响的实践分析

Practical analysis of anticoagulant effect of warfarin in anticoagulant therapy management outpatient

作者：彭文星张雨雯徐晓宇石秀锦林阳

英文作者：Peng Wenxing Zhang Yuwen Xu Xiaoyu Shi Xiujin Lin Yang

单位：首都医科大学附属北京安贞医院药事部100029

英文单位：Department of Pharmacy Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：抗凝药物治疗管理门诊；华法林；药师

英文关键词：Anticoagulanttherapymanagementoutpatient;Warfarin;Pharmacist

• 摘要：

• 目的 探讨抗凝药物治疗管理门诊对华法林抗凝效果的影响。方法 回顾性分析2019年7月至2020年1月于首都医科大学附属北京安贞医院抗凝药物治疗管理门诊拟服用或正在服用华法林的患者64例。记录患者一般情况、就诊目的 、国际标准化比值（INR）、INR达稳时间、治疗范围内的时间百分比（TTR）、出血及血栓事件。结果 患者平均年龄（60±12）岁，5例未戒烟、3例未戒酒，17例（26.6%）合并高血压，35例（54.7%）为机械瓣膜置换术后。患者共就诊143例次，109例次就诊目的 为调整华法林剂量，此外，门诊药师监护患者异常情况29例次、更改其他抗凝药物12例次。可随访至华法林达稳的患者共17例，第5次就诊起INR水平逐渐趋于稳定，9例（52.9%）INR达稳时间<28 d，4例（23.5%）28 d≤INR达稳时间＜42 d，2例（11.8%）42 d≤INR达稳时间＜64 d，2例（11.8%）INR达稳时间≥64 d；2例（11.8%）TTR<40%、2例（11.8%）40%≤TTR＜60%、10例（58.8%）60%≤TTR＜80%、3例（17.6%）TTR≥80%，中位TTR为69.05%（63.05%，75.96%）。用药期间发生小出血事件共有13例次，11例次发生在患者自行服用药物或于当地医院就诊期间，2例次发生在抗凝药物治疗管理门诊就诊期间。所有患者服药期间无血栓事件发生。结论 以药师为主的抗凝治疗管理门诊可以为患者提供全面的、连续的治疗药物管理，提高患者依从性。

• Objective To explore the effects of anticoagulant therapy management outpatient on anticoagulant effect of warfarin. Methods Totally 64 patients who planned to take or had taken warfarin in  the anticoagulant therapy management outpatient of Beijing Anzhen Hospital, Capital Medical University from July 2019 to January 2020 were analyzed retrospectively. The general data, purpose of treatment, international normalized ratio (INR), reaching stability time of INR, percent of time in therapeutic range (TTR), and events of bleeding and thrombotic were recorded. Results  The average age of patients was (60±12)years, 5 cases did not quit smoking, 3 cases did not quit drinking, 17 cases(26.6%) were complicated with hypertension, and 35 cases(54.7%) underwent mechanical valve replacement. A total of 143 times of consultation were made, 109 times (76.2%) with purpose of adjusting warfarin dose. In addition, 29 times were monitored by outpatient pharmacists for abnormal conditions and 12 times for adjusting other anticoagulants. A total of 17 patients were followed-up to warfarin reaching stabilization, and the INR level tended to be stable gradually. There were 9 cases(52.9%) reaching stability time of INR<28 d, 4 cases(23.5%) 28 d≤reaching stability time of INR<42 d, 2 cases(11.8%) 42 d≤reaching stability time of INR<64 d, and 2 cases(11.8%) reaching stability time of INR≥64 d. There were 2 cases(11.8%) TTR<40%, 2 cases(11.8%) 40%≤TTR<60%, 10 cases(58.8%) 60%≤TTR<80%, and 3 cases(17.6%) TTR≥80%, and median TTR was 69.05%（63.05%, 75.96%）. A total of 13 times minor bleeding event occurred during medication, 11 times occurrence during patients taking medication by themselves or visiting local hospitals, and 2 times occurrence during anticoagulant therapy management outpatient consultation. There was no thrombotic event during medication on patients. Conclusion Anticoagulant therapy management outpatient based on pharmacists can provide comprehensive and continuous treatment medication management, and improve patients′ compliance.