广州市某医院华法林临床使用情况调查Investigation of Warfarin Clinical Application in A Hospital of Guangzhou
黄玉玲,崔惠仪,余永杰
HUANG Yuling,CUI Huiyi,YU Yongjie
摘要(Abstract)：
目的探讨广州市某医院华法林临床使用情况,为华法林的抗凝管理提供依据。方法回顾性调查2013-01-01~2013-12-31在本院诊断为二尖瓣狭窄合并房颤、肺栓塞、瓣膜置换术后、下肢静脉血栓病且坚持在本院随访1年的门诊病例,调查华法林使用率、维持剂量、INR值和监测次数、不良反应和合并用药等。结果共纳入有效病例224例,47.3%使用了华法林,79.2%的患者日维持剂量介于1.5~3.0 mg,24.5%的患者能定期监测INR,93.4%的患者INR达标率<50%,52.8%的患者规律用药,7例患者发生了9例次华法林相关出血事件,合并用药中有6大类药物可能影响华法林抗凝效果。结论华法林的使用率及达标率偏低,患者依从性差,开展华法林抗凝管理具有重要意义。
OBJECTIVE To investigate clinical application of warfarin were,so as to provide reference for the management of warfarin anticoagulant therapy. METHODS Patients who taken oral warfarin therapy for mitral stenosis atrial fibrillation( AF),pulmonary embolism( PE),mechanical valve replacement and lower extremity deep venous thrombosis( DVT) during the period of Jan.1. 2013-Dec.31. 2013 and followed-up for one year were retrospectively studied. The application proportion of warfarin,maintenance dose,international normalized ratio( INR) monitor,compliance,side effects as well as combined medication were investigated.RESULTS A total of 224 patients were included in the study. 47.3% of the patients used warfarin,of whom 79.2% received 1.5-3.0mg warfarin,24.5% monitored INR regularly,93.4% had the INR less than 50% target range,52.8% adherence to warfarin therapy,7patients occurred 9 case of warfarin related bleeding complications. 6 kinds of drug could interact with warfarin. CONCLUSION Warfarin was underused. The rate of INR in the target range and patient adherence to medical recommendations were poor. It is necessary to carry out management of warfarin anticoagulant therapy.
关键词(KeyWords)：
华法林;临床使用;调查
warfarin;clinical application;investigation
基金项目(Foundation):
作者(Author):
黄玉玲,崔惠仪,余永杰
HUANG Yuling,CUI Huiyi,YU Yongjie
参考文献(References)：
- [1]Hirsh J,Fuster V,Ansell J,et al.American Heart Association/American College of Cardiology Foundation guide to warfarin therapy[J].J Am Coll Cardiol,2003,4l(9):1633-1652.
- [2]中华医学会心血管病学分会,中国老年学学会心脑血管病专业委员会.华法林抗凝治疗的中国专家共识[J].中国内科杂志,2013,52(1):76-82.
- [3]秦中胜,崔花花,潘三葱,等.142例心房颤动住院患者华法林使用情况的回顾性分析[J].中西医结合心脑血管病杂志,2008,6(10):1213-1214.
- [4]左惠娟,苏江莲,林运.门诊非瓣膜性心房颤动患者抗凝治疗及其依从性分析[J].中国医药,2010,5(9):806-808.
- [5]Lim LY,Chong VH,Rajendran N,et al.A cross-sectional study of the Anticoagulation clinic in RIPAS Hospital,Brunei[J].J Thromb Thrombolysis,2009,28(2):140-145.
- [6]戚文航.中国部分地区心房颤动住院病例回顾性调查[J].中华心血管病杂志,2003,31(12):913-916.
- [7]孙艺红,胡大一.华法林对中国人心房颤动患者抗栓的安全性和有效性研究[J].中华内科杂志,2004,43(4):258-260.
- [8]Park SM,Lee JK,Chun SI,et al.VKORC1 and CYP2C9 Genotype Variations in Relation to Warfarin Dosing in Korean Stroke Patients[J].J Stroke,2013,15(2):115-121.
- [9]Shuaib W,Iftikhar H,Alweis R,et al.Warfarin Therapy:Survey of Patients'Knowledge of their Drug Regimen[J].Malays J Med Sci,2014,21(4):37-41.
- [10]左惠娟,苏江莲,林运,等.住院心房颤动患者抗凝治疗依从性及疾病管理需求分析[J].中华医学杂志,2010,90(32):2246-2249.
- [11]何培根,闵新文,郑芳.华法林钠药理作用影响因素与华法林钠用药监护[J].医药导报,2011,30(5):668-671.