中国临床药学杂志

目的 探讨临床药师对综合医院门诊华法林抗凝患者管理的效果。方法 选择2019年3至6月在心内科门诊就诊的接受华法林治疗患者200例，随机分为干预组（临床药师参与管理）和对照组（医师管理），分别开展1年的随访研究。以国际标准化比值（INR）在治疗范围内的时间比（TTR）作为评估抗凝效果的指标。结果 共有175例患者完成研究，其中干预组88例，对照组87例。干预6个月和12个月后，干预组患者的TTR均高于对照组（干预6个月，71.33±20.74vs46.16±28.85,P <0.001；干预12个月，66.84±18.93 vs 44.75±24.64,P <0.001）。在干预组中，主动干预期和非主动干预期结束后的抗凝认知评分（5.97±1.22和5.52±1.16）均高于入组后首次随访（3.27±1.18），差异均有高度统计学意义（P <0.001）；主动干预期和非主动干预期间的INR监测次数[（6.03±1.23）次和（5.41±1.13）次]也多于入组前6个月[（4.91±1.22）次，P <0.001）]。干预组在研究期间出血异常性波动事件（INR> 4.5）的发生率事件低于对照组（4.55%vs 6.90%,P=0.731），出血和栓塞事件发生率也低于对照组（0 vs 2.30%,P=0.246），而其他心脑血管入院事件发生率则高于对照组（13.64%vs11.49%,P=0.669）。结论 在抗凝效果上，临床药师对综合医院门诊华法林抗凝患者的管理比医师管理组更有效，而在安全性方面差异不明显。

AIM To explore the effect of clinical pharmacists on the management of warfarin anticoagulation patients in outpatient department of general hospital. METHODS From March to June in 2019, 200 patients treated with warfarin in the clinic of cardiology were randomly divided into clinical pharmacist-intervention group and control group(physician management group) for 1-year follow-up study, the international standardized ratio(INR) and time in therapeutic range(TTR) was used to evaluate the anticoagulation effect. RESULTS A total of 175 patients completed the study, including 88 patients in intervention group and 87 patients in control group. TTR was higher in the intervention group than in the control group at 6 months(71.33 ± 20.74 vs 46.16 ± 28.85, P < 0.001) and 12 months(66.84 ± 18.93 vs 44.75 ± 24.64, P < 0.001). In pharmacist-intervention group, the anticoagulation cognitive score(5.97 ± 1.22 and 5.52 ± 1.16)after the active intervention and non-active intervention period was higher than that after the first follow-up(3.27 ± 1.18),with high statistical significance(P < 0.001). The number of INR monitoring in the active intervention period and the nonactive intervention period [(6.03 ± 1.23) times and(5.41 ± 1.13) times] was also higher than that in the first 6 months [(4.91 ± 1.22) times, P < 0.001]. The incidence of abnormal fluctuation events of bleeding(INR > 4.5) during the study period was lower in the intervention group than in the control group(4.55% vs 6.90%, P = 0.731), and the incidence of bleeding and embolism events was also lower in the control group(0 vs 2.30%, P = 0.246). The incidence of other cardiovascular and cerebrovascular events of the intervention group was higher than that of the control group(13.64%vs 11.49%, P = 0.669). CONCLUSION In terms of inticoagulation effect clinical pharmacis' management of warfarin anticoagulation patients in outpatients of general hospitals is more effective than that of physician management group, but there is no significant difference in safety.