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目的:了解华法林临床应用中存在的问题,为提高其用药合理水平提供参考。方法:收集北京安贞医院2010年1至5月期间住院时间超过7 d、应用华法林并进行国际标准化比值(INR)监测患者的病历,记录患者年龄、性别、华法林用药剂量及时间I、NR监测次数及达标情况以及不良反应等。按原发疾病将患者分为人工机械心脏瓣膜置换术组(AMH组)、心房颤动组(AF组)和其他疾病组(OD组)进行比较。结果:共收集到住院患者339例,AMH组252例(男性142例,女性110例,年龄11～78岁),AF组33例(男性23例,女性10例,年龄20～84岁),OD组54例(男性38例,女性16例,年龄12～77岁)。AMH组、AF组、OD组用药剂量中位数分别为3.0(1.5,6.0)、3.0(1.5,3.0)、3.0(1.5,6.0)mg,用药时间中位数分别为9(2,61)、5(2,15)和10(2,42)d,AMH组用药剂量高于AF组(P<0.01),AMH组和OD组用药时间长于AF组(P<0.01);INR监测次数中位数分别为5(2,21)、1(1,2)和6(1,20)次;华法林最终INR达标率分别为40.9%(103/252)、12.1%(4/33)和46.3%(25/54),未达标率分别为10.7%(27/252),84.8%(28/33),和38.9%(21/54),超范围率分别为48.4%(122/252)、3.1%(1/33)和14.8%(85/54),AMH组与AF组患者之间,AF组与OD组患者之间,华法林INR达标率差异均有统计学意义;3组患者之间两两比较未达标率差异均有统计学意义(均P<0.01);AMH组与AF组患者之间,AMH组与OD组患者之间超范围率差异有统计学意义(均P<0.01)。用药期间出现转氨酶可逆性升高者71例(20.9%),胃纳不佳或恶心呕吐8例(2.4%),腹泻5例(1.5%),鼻出血2例(0.6%),凝血时间延长1例(0.3%)。结论:我院住院患者华法林INR总体达标率不高,尤其是AF组患者;而AMH组患者华法林INR超范围率较高。提示应用华法林时要注意监测INR以提高用药的合理性,应定期监测患者肝功能和出凝血指标以减少不良反应的发生。
Objective: To understand the problems existing in the clinical application of warfarin and provide references for improving the reasonable level of its use. Methods: The hospitalization time of Ahn Jung Hospital in Beijing from January to May 2010 was collected for more than 7 days. The patient’s medical record was monitored with warfarin and international standardization ratio (INR). The patient’s age, sex, warfarin dose and time I, NR monitoring times and compliance standards and adverse reactions. Patients were divided into primary mechanical valve replacement group (AMH group), atrial fibrillation group (AF group) and other disease groups (OD group) according to the primary disease. Results: A total of 339 hospitalized patients were enrolled, including 252 AMH patients (142 males and 110 females, aged 11-78 years) and 33 AF patients (23 males and 10 females, aged 20-84 years) There were 54 cases in OD group (38 males and 16 females, aged 12-77 years). Median doses of AMH, AF and OD were 3.0 (1.5,6.0), 3.0 (1.5,3.0) and 3.0 (1.5,6.0) mg, respectively. The median duration of medication was 9 (2,61) , 5 (2,15) and 10 (2,42) d respectively. The dosage of AMH group was higher than that of AF group (P <0.01), AMH group and OD group were longer than AF group (P <0.01) The median compliance rates of warfarin were 40.9% (103/252) and 12.1% (4/33), respectively, with the median of 5 (2,21), 1 (1,2) and 6 And 46.3% (25/54) respectively. The non-compliance rates were 10.7% (27/252), 84.8% (28/33) and 38.9% (21/54), respectively. The out-of-range rates were 48.4% ), 3.1% (1/33) and 14.8% (85/54) respectively. There was significant difference in the compliance rate of warfarin INR between AMH group and AF group and between AF group and OD group. 3 (P <0.01). There was significant difference in overrange rate between AMH group and AF group, AMH group and OD group (both P <0.01) P <0.01). 71 cases (20.9%) had reversible increase of aminotransferase, 8 cases (2.4%) had poor appetite or nausea and vomiting, 5 cases (1.5%) had diarrhea, 2 cases (0.6%) had nasal hemorrhage, 1 case (0.3%). CONCLUSIONS: The overall compliance rate of warfarin INR in hospitalized patients in our hospital is not high, especially in patients in AF group. INR in AMH patients is higher than that in warfarin INR. Tip warfarin should pay attention to monitoring INR to improve the rationality of medication, should be regularly monitored in patients with liver function and coagulation indicators to reduce the incidence of adverse reactions.