基于Granada-Ⅱ分类法评价非维生素K拮抗剂口服抗凝药物用于非瓣膜性心房颤动患者的药物相关问题

丁华敏; 钱淑雨; 苏锦文; 潘忙忙; 王昕; 顾智淳; 张弛

doi:10.13748/j.cnki.issn1007-7693.20243160

基于Granada-Ⅱ分类法评价非维生素K拮抗剂口服抗凝药物用于非瓣膜性心房颤动患者的药物相关问题

Evaluation of Drug-related Problems of Non-vitamin K Antagonist Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation Based on Granada-Ⅱ Classification Method

摘要

摘要:
目的探讨非维生素K拮抗剂口服抗凝药(non-vitamin K antagonist oral anticoagulants，NOACs)用于非瓣膜性心房颤动(non-valvular atrial fibrillation，NVAF)患者的药物相关问题(drug-related problems，DRPs)，以促进临床合理使用。
方法利用院内信息系统，抽取2023年度上海市浦东新区浦南医院心血管内科使用利伐沙班、艾多沙班、达比加群酯的NVAF患者病例，以药品说明书、指南、专家共识为基础，采用Granada-Ⅱ分类法对患者使用上述3种药物的必要性(包括DRP1和DRP2)、有效性(包括DRP3和DRP4)、安全性(包括DRP5和DRP6)进行评价。
结果纳入276例病例，发生DRPs共计95例(34.42%)，包括有效性DRP4 58例(21.01%)，安全性DRP5 29例(10.51%)和DRP6 8例(2.89%)，均未发生DRP1、DRP2、DRP3的情况。
结论该院心血管内科NVAF患者使用NOACs的主要DRPs为有效性问题，需加强药学干预，促进合理用药。

Abstract:
OBJECTIVE To investigate the drug-related problems(DRPs) of non-vitamin K antagonist oral anticoagulants(NOACs) in patients with non-valvular atrial fibrillation(NVAF), and to promote the rational use of NOACs in the clinic.
METHODS By making use of the hospital's internal information system, cases of NVAF patients who used rivaroxaban, edoxaban and dabigatran etexilate in the Department of Cardiovascular Medicine of Shanghai Punan Hospital of Pudong New District in 2023 were extracted. Based on the drug instructions, guidelines and expert consensus, the Granada Ⅱ classification method was used to evaluate the necessity(including DRP1 and DRP2), effectiveness(including DRP3 and DRP4), and safety(including DRP5 and DRP6) of using the three drugs mentioned above in patients.
RESULTS A total of 276 cases were included, with 95 cases(34.42%) of DRPs, including 58 cases(21.01%) of DRP4, 29 cases(10.51%) of DRP5, and 8 cases(2.89%) of DRP6. The cases of DRP1, DRP2 or DRP3 didn't occurred.
CONCLUSION DRPs in patients with NVAF in the Department of Cardiovascular Medicine in the hospital are mainly the effectiveness. It is necessary to strengthen pharmaceutical intervention, so as to promote the rational use of drug.

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