非瓣膜性房颤患者抗凝治疗影响因素分析

Factors Analysis of Anticoagulant Treatment of Patients with Non-valvular Atrial Fibrillation

关键词:  非瓣膜房颤  抗凝治疗  影响因素  用药教育  监测频率

Key words:  non-valvular atrial fibrillation  anticoagulant treatment  influence factors  medical education  monitoring frequency

摘要:

目的 调查住院非瓣膜性房颤患者抗凝治疗情况，分析可能影响抗凝治疗的因素，探讨临床药师在抗凝管理中发挥的作用。方法 收集常州市第一人民医院住院非瓣膜性房颤患者238例，对抗凝药物选择、剂量、国际标准化比值（international standardized ratio，INR）、凝血功能监测频率、合并用药、基础疾病、出血并发症、用药教育等进行回顾性分析。结果 非瓣膜性房颤患者卒中风险评分（CHA₂DS₂-VASc评分）≥2分者规范抗凝覆盖率48.8%，年龄和合并冠心病会影响临床抗凝药物选择，临床药师为患者提供用药教育对患者抗凝治疗接受度影响具有显著统计学意义（P<0.01）。出院前INR在目标值范围内的患者仅占38.16%（29/76），TTRs平均值为（49.57±3.68）%。年龄、性别、华法林初始剂量、出血风险、合并用药等不影响INR达标情况，合并疾病中仅消化道疾病与INR达标间存在统计学意义（P=0.027），住院期间患者凝血功能监测频率也影响患者INR达标率（P=0.038）。结论 目前住院非瓣膜性房颤患者的规范抗凝覆盖率仍较低，临床药师可充分利用自身专业知识，开展患者抗凝药物用药教育，积极参与到抗凝管理中，提高抗凝期间凝血功能监测频率，提高抗凝达标率，促进卒中防治效果。

Abstract:

OBJECTIVE To investigate the application of anticoagulant therapy in patients with non-valvular atrial fibrillation, analyze the factors that may affect anticoagulation therapy, and explore the role of clinical pharmacists in anticoagulation management. METHODS Two hundred thirty eight patients with non-valvular atrial fibrillation who were admitted to The Third Affiliated Hospital of Soochow University were collected for retrospective analysis of anticoagulant drug selection, dosage, international standardized ratio(INR), monitoring frequency of coagulation function, combined medication, basic diseases and hemorrhagic complications, medical education. RESULTS The standardized anticoagulant coverage rate was 48.8% in the patients with non-valvular atrial fibrillation with stroke risk score(CHA₂DS₂-VAS_c score) ≥ 2, age and combining with coronary heart disease might affect the clinical anticoagulant drugs selection, and clinical pharmacists provided medication education for patients had significant statistical significance(P< 0.01) whether patients accepted anticoagulant therapy. Before discharge, only 38.16%(29/76) of the patients in the target range were treated, and the average TTRs was(49.57±3.68)%. Age, gender, initial dose of warfarin, bleeding risk, drug combination did not affect the INR meeting to treatment standard, only combined with digestive tract disease had statistical significance(P=0.027). Monitoring frequency of coagulation function in patients also affects INR success rate(P=0.038). CONCLUSION At present coverage rate of anticoagulant therapy of hospitalized patients with non-valvular atrial fibrillation is still low, clinical pharmacists can make full use of their own professional knowledge, provide medical education for patients who need anticoagulant therapy, actively involve in the anticoagulation management, improve monitoring frequency of coagulation function during the anticoagulation and improve the anticoagulation success rate, promote the control effect of stroke.