NOACs用药教育对心房颤动患者抗凝认知水平的影响
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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)在心房颤动患者中的最佳用药教育策略,用于有效提高心房颤动患者抗凝认识水平。方法 依据NOACs说明书及相关心房颤动治疗指南,制定10条心房颤动患者NOACs用药知识教育内容,依据自制用药教育程序进行宣教,比较用药教育前、后心房颤动患者对NOACs抗凝知识的知晓情况。结果 该10条心房颤动患者NOACs用药教育问题包含了NOACs必备知识,采用该用药教育策略对心房颤动患者进行用药教育后,NOACs知识知晓率由教育前的0～56.25%提高至100.00%,差异有显著的统计学意义(均P <0.01)。结论 该用药教育策略可有效提升临床药师的工作效率,而且用药教育质量较好,效果显著,值得临床药师借鉴。
Objectives To explore the best medication education strategy for non-vitamin K antagonist oral anticoagulant drugs(NOACs) in patients with atrial fibrillation, in order to effectively improve the cognitive level about anticoagulation of patients with atrial fibrillation. Methods According to the NOACs instructions and related treatment guidelines for atrial fibrillation, ten points of NOACs medication education knowledge for patients with atrial fibrillation were established.According to the selfmedication education program, the patients' acknowledgments of NOACs anticoagulation before and after education were compared. Results NOACs medication education contained essential information of NOACs. After the education was well performed, the knowledge awareness rate of NOACs increased from 0 to 56.25% before education to100.00%(P<0.01). Conclusion This medication education strategy can effectively improve the efficiency of pharmacists.The quality of medication education is significantly good. It is worthy for pharmacists to take some advantages of this strategy.
Objectives To explore the best medication education strategy for non-vitamin K antagonist oral anticoagulant drugs(NOACs) in patients with atrial fibrillation, in order to effectively improve the cognitive level about anticoagulation of patients with atrial fibrillation. Methods According to the NOACs instructions and related treatment guidelines for atrial fibrillation, ten points of NOACs medication education knowledge for patients with atrial fibrillation were established.According to the selfmedication education program, the patients' acknowledgments of NOACs anticoagulation before and after education were compared. Results NOACs medication education contained essential information of NOACs. After the education was well performed, the knowledge awareness rate of NOACs increased from 0 to 56.25% before education to100.00%(P<0.01). Conclusion This medication education strategy can effectively improve the efficiency of pharmacists.The quality of medication education is significantly good. It is worthy for pharmacists to take some advantages of this strategy.
引文
[1]Prystowsky EN,Padanilam BJ,Fogel RI.Treatment of atrial fibrillation[J].J Am Med Assoc,2015,314(3):278-288.
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[4]Kirchhof P.The future of atrial fibrillation management:integrated care and stratified therapy[J].Lancet,2017,390(10105):1873-1887.
[5]Lopez-Lopez JA,Sterne JAC,Thom HHZ,et al.Oral anticoagulants for prevention of stroke in atrial fibrillation:system aticreview,network meta-analysis,and cost effectiveness analysis[J].Br Med J,2017,359:j5058-j5058.
[6]Steffel J,Verhamme P,Potpara TS,et al.The 2018 European heart rhythm association practical guide on the use of nonvitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J].Europace,2018,20(8):1231-1242.
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[8]郑晓圆,沈珑,韦兆玲,等.抗凝团队在房颤患者围术期抗凝宣教中的作用和价值[J].中国药师,2019,22(2):287-290.
[9]黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议-2015[J].中华心律失常学杂志,2015,19(5):321-384.
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[11]汤继军,李强.利伐沙班联合低分子右旋糖酐治疗下肢急性周围型深静脉血栓的临床评价[J].世界临床药物,2017,38(8):554-558.
[12]徐蕾,杨婉花.达比加群酯抗凝治疗的安全性研究进展[J].世界临床药物,2016,37(11):781-785.
[13]Patel MR,Mahaffey KW,Garg J,et al.Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J].N Engl J Med,2011,365(10):883-891.
[14]Connolly SJ,Ezekowitz MD,Yusuf S,et al.Dabigatran versus warfarin in patients with atrial fibrillation[J].N Engl J Med,2009,361(12):1139-1151.
[15]Zhang C,Gu ZC,Ding Z,et al.Decreased risk of renal impairment in atrial fibrillation patients receiving nonvitamin K antagonist oral anticoagulants:a pooled analysis of randomized controlled trials and real-world studies[J].Thromb Res,2019,174:16-23.
[16]Zhou LY,Yang SF,Zhang Z,et al.A renal function based tradeoff analysis of non-vitamin K antagonist oral anticoagulants in nonvalvular atrial fibrillation[J].Front Physiol,2018,9:1644-1644.
[17]Gu ZC,Zhou LY,Shen L,et al.Non-vitamin K antagonist oral anticoagulants vs.warfarin at risk of fractures:a systematic review and meta-analysis of randomized controlled trials[J].Front Pharmacol,2018,9:348-348.
[18]Zhang C,Gu ZC,Shen L,et al.Non-vitamin K antagonist oral anticoagulants and cognitive impairment in atrial fibrillation:insights from the meta-analysis of over 90,000 patients of randomized controlled trials and real-world studies[J].Front Aging Neurosci,2018,10:258.
[19]魏钧伯,魏盟.2015欧洲心脏病学会老年人抗栓治疗专家共识解读[J].世界临床药物,2016,37(5):304-307.
[20]Voukalis C,Lip GY,Shantsila E.Drug-drug interactions of non-vitamin K oral anticoagulants[J].Expert Opin Drug Metab Toxicol,2016,12(12):1445-1461.
[21]Shang DW,Wang ZZ,Hu HT,et al.Effects of food and grapefruit juice on single-dose pharmacokinetics of blonanserin in healthy Chinese subjects[J].Eur J Clin Pharmacol,2018,74(1):61-67.
[22]Ainslie GR,Wolf KK,Li Y,et al.Assessment of a candidate marker constituent predictive of a dietary substance-drug interaction:case study with grapefruit juice and CYP3A4 drug substrates[J].J Pharmacol Exp Ther,2014,351(3):576-584.
[23]Gu ZC,Ma XW,Zheng XY,et al.Left atrial appendage thrombus formation in a patient on dabigatran therapy associated with ABCB1 and CES-1 genetic defect[J].Front Pharmacol,2018,9:491-491.
[24]Gu ZC,Shi FH,Zhu J,et al.The management of heavy menstrual bleeding after percutaneous coronary intervention in a woman of reproductive age[J].Front Pharmacol,2019,9:1573-1573.
[2]Zungsontiporn N,Link MS.Newer technologies for detection of atrial fibrillation[J].Br Med J,2018,363:k3946-k3946.
[3]Schnabel RB,Yin X,Gona P,et al.50 year trends in atrial fibrillation prevalence,incidence,risk factors,and mortality in the Framingham heart study:a cohort study[J].Lancet,2015,386(9989):154-162.
[4]Kirchhof P.The future of atrial fibrillation management:integrated care and stratified therapy[J].Lancet,2017,390(10105):1873-1887.
[5]Lopez-Lopez JA,Sterne JAC,Thom HHZ,et al.Oral anticoagulants for prevention of stroke in atrial fibrillation:system aticreview,network meta-analysis,and cost effectiveness analysis[J].Br Med J,2017,359:j5058-j5058.
[6]Steffel J,Verhamme P,Potpara TS,et al.The 2018 European heart rhythm association practical guide on the use of nonvitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J].Europace,2018,20(8):1231-1242.
[7]Chang SH,Chou IJ,Yeh YH,et al.Association between use of non-vitamin k oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation[J].J Am Med Assoc,2017,318(13):1250-1259.
[8]郑晓圆,沈珑,韦兆玲,等.抗凝团队在房颤患者围术期抗凝宣教中的作用和价值[J].中国药师,2019,22(2):287-290.
[9]黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议-2015[J].中华心律失常学杂志,2015,19(5):321-384.
[10]宫平,贾薇.新型口服抗凝血药物达比加群酯[J].世界临床药物,2008,29(9):544-547.
[11]汤继军,李强.利伐沙班联合低分子右旋糖酐治疗下肢急性周围型深静脉血栓的临床评价[J].世界临床药物,2017,38(8):554-558.
[12]徐蕾,杨婉花.达比加群酯抗凝治疗的安全性研究进展[J].世界临床药物,2016,37(11):781-785.
[13]Patel MR,Mahaffey KW,Garg J,et al.Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J].N Engl J Med,2011,365(10):883-891.
[14]Connolly SJ,Ezekowitz MD,Yusuf S,et al.Dabigatran versus warfarin in patients with atrial fibrillation[J].N Engl J Med,2009,361(12):1139-1151.
[15]Zhang C,Gu ZC,Ding Z,et al.Decreased risk of renal impairment in atrial fibrillation patients receiving nonvitamin K antagonist oral anticoagulants:a pooled analysis of randomized controlled trials and real-world studies[J].Thromb Res,2019,174:16-23.
[16]Zhou LY,Yang SF,Zhang Z,et al.A renal function based tradeoff analysis of non-vitamin K antagonist oral anticoagulants in nonvalvular atrial fibrillation[J].Front Physiol,2018,9:1644-1644.
[17]Gu ZC,Zhou LY,Shen L,et al.Non-vitamin K antagonist oral anticoagulants vs.warfarin at risk of fractures:a systematic review and meta-analysis of randomized controlled trials[J].Front Pharmacol,2018,9:348-348.
[18]Zhang C,Gu ZC,Shen L,et al.Non-vitamin K antagonist oral anticoagulants and cognitive impairment in atrial fibrillation:insights from the meta-analysis of over 90,000 patients of randomized controlled trials and real-world studies[J].Front Aging Neurosci,2018,10:258.
[19]魏钧伯,魏盟.2015欧洲心脏病学会老年人抗栓治疗专家共识解读[J].世界临床药物,2016,37(5):304-307.
[20]Voukalis C,Lip GY,Shantsila E.Drug-drug interactions of non-vitamin K oral anticoagulants[J].Expert Opin Drug Metab Toxicol,2016,12(12):1445-1461.
[21]Shang DW,Wang ZZ,Hu HT,et al.Effects of food and grapefruit juice on single-dose pharmacokinetics of blonanserin in healthy Chinese subjects[J].Eur J Clin Pharmacol,2018,74(1):61-67.
[22]Ainslie GR,Wolf KK,Li Y,et al.Assessment of a candidate marker constituent predictive of a dietary substance-drug interaction:case study with grapefruit juice and CYP3A4 drug substrates[J].J Pharmacol Exp Ther,2014,351(3):576-584.
[23]Gu ZC,Ma XW,Zheng XY,et al.Left atrial appendage thrombus formation in a patient on dabigatran therapy associated with ABCB1 and CES-1 genetic defect[J].Front Pharmacol,2018,9:491-491.
[24]Gu ZC,Shi FH,Zhu J,et al.The management of heavy menstrual bleeding after percutaneous coronary intervention in a woman of reproductive age[J].Front Pharmacol,2019,9:1573-1573.