摘要
目的探寻近年来国内非维生素K拮抗剂口服抗凝药(NOAC)使用情况,并根据结果提出建议.方法从我国7座城市80家医院抽取76292张含有NOAC的门诊处方进行统计分析,并与药品说明书、最新用药指南等循证医学证据进行对比.结果开具NOAC处方患者的平均年龄为69岁,男女比例为1:0.91.处方总量呈逐年上升趋势.上海、北京和广州的处方量占比最大.诊断为心房颤动、下肢深静脉血栓和肺栓塞的处方占比最大,高达32.23%的处方为适应证不适宜或无适应证用药.1.95%涉及利伐沙班的处方和9.22%涉及达比加群酯的处方用法不适宜,其中24张涉及达比加群酯的处方用法需将胶囊打开服用.高龄、肾功能损伤、肝功能损伤及出血诊断的处方比例较低,但多数未标明损伤程度.1张含利伐沙班的处方诊断为风湿性心脏病人工瓣膜置换术后.结论NOAC逐渐被越来越多的患者所接受.处方在药品适应证方面的不合理情况较多.特殊人群剂量调整和禁忌证方面的处方规范性有待加强.
Objective To investigatc the use of non-vitamin K antagonist oral anticoagulant(NOAC)in China in recent years and put forward some suggestions according to the results.Methods A otal of 76292 prescriptions containing NOAC were selected from 80 hospitals in seven cities of China for statistical analysis.The results were compared with the evidence of evidence-based medicine,such as the drug instruction manual and he latest drug use guide.Results The average age of the patients prescribed NOAC was 69 and the ratio of men to women is 1:0.91.The total amount of prescriptions rised year by year.Shanghai,Beijing and Guangzhou account for the largest share of the prescriptions.Atrial fibrillation,deep venous thrombosis and pulmonary embolism accounted for the largest proportion of the prescriptions,with up to 32.23%of the prescriptions being inappropriate or unindicated.1.95%of the prescriptions involving rivaroxaban and 9.22%of the prescriptions involving dabigatran were inappropriatc;twenty-four of the prescriptions involving dabigatran were taken by opening the capsule.The proportions of the prescriptions for diagnosis of advanced age,renal function injury,,liver function injury and hemorrhage were lower,but the degree of injury is not indicated in most cases.A prescription containing rivaroxaban was given for diagnosis of rheumatic heart disease following prosthetic valve replacement.Conclusion NOAC are gradually accepted by more and more patients.There are many unreasonable cases now in the indication of drugs in prescription.The dosage adjustment and contraindications in special populations need to be strengthened.
作者
赵紫楠
李可欣
薛薇
胡欣
ZHAO Zi-nan;LI Ke-xin;XUE Wei;HU Xin(Department of Pharmacy,Beijing Hospital,Assessment of Clinical Drugs Risk and Individual Application Key Laboratory,Beijing 100730,China;Clinical Trial Center,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中国心血管病研究》
CAS
2020年第7期577-581,共5页
Chinese Journal of Cardiovascular Research
基金
“国家重大新药创制”科技重大专项(2017zx09101001002002)。
关键词
非维生素K拮抗剂口服抗凝药
处方
临床应用
Non-vitamin K antagonist oral anticoagulant
Prescription
Clinical application
