目的 评价老年住院患者抗凝药物潜在不适当用药(PIM)情况.方法 采用系统抽样法,收集2016年新疆医科大学附属中医医院年龄≥65岁同时使用抗凝药物的住院患者192例,基于2015版Beers标准老年患者基于肾功能尽可能避免或减少剂量的非感染药物种类及建议、药品说明书及抗凝治疗、预防深静脉血栓(DVT)等指南中推荐的给药方法,结合医院抗凝药物目录(依诺肝素注射液和利伐沙班片,不包括华法林),整理适合住院老年患者抗凝治疗PIM评价的标准,评价PIM发生情况.结果 192例患者中,PIM发生率为43.8%(84/192).使用利伐沙班40例,PIM发生率为20.0%(8/40);使用依诺肝素152例,PIM发生率为50.0%(76/152).发生PIM患者中,内科预防DVT 30例(35.7%),急性冠脉综合征(ACS)抗凝治疗21例(25.0%),骨科术后预防DVT 10例(11.9%),心房纤颤抗凝治疗8例(9.5%),其他抗凝指征15例(17.9%);主要表现为疗程不足(31例,36.9%)、剂量不足(20例,23.8%)、基于肾功能尽可能避免或减少剂量(17例,20.2%)、其他不合理原因(16例,19.1%).结论 老年住院患者抗凝药物使用存在PIM情况,应采取综合措施预防不合理用药.%Objective This study aimed to evaluate the potentially inappropriate use of anticoagulant drugs in elderly inpatients.Methods Using systematic sampling,we selected 192 elderly inpatients(≥ 65 years) receiving anticoagulant therapy in Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University in 2016. We developed potentially inappropriate medication (PIM) evaluation criteria for anticoagulation therapy in older adults based on the review of the lists and recommended administration methods of non-anti-infective drugs in 2015 American Geriatrics Society Beers Criteria that should be avoided or have their dose adjusted in accordance with the individual's kidney function,drug package inserts, methods of administration proposed in the guidelines for anticoagulation and deep vein thrombosis(DVT) prophylaxis,and the list of anticoagulation drugs for hospitals (enoxaparin injection and rivaroxaban tablets,not including warfarin),and used this criteria to assess the incidence of PIM in these participants.Results Among the 192 patients,the incidence of PIM was 43.8% (84/192). Specifically,the incidence of PIM among the 40 patients using rivaroxaban and 152 using enoxaprin was 20.0% (8/40) and 50.0% (76/152),respectively. The PIM cases included deep venous thrombosis (DVT) prevention (n=30, 35.7%),acute coronary syndrome anticoagulant therapy (n=21,25.0%),DVT prevention after orthopedic surgery (n=10,11.9%),anticoagulation therapy for atrial fibrillation (n=8,9.5%),and other indications for anticoagulation(n=15,17.9%). The inappropriate use of medications mainly included insufficient duration of anticoagulant therapy (n=31, 36.9%),insufficient dose of anticoagulants (n=20,23.8%),avoiding or reducing the dosage due to renal function (n=17, 20.2%),and other inappropriate usage (n=16,19.1%).Conclusion Anticoagulant drug use in elderly inpatients frequently departs from professional recommendations and guidelines,thus comprehensive measures should be taken to prevent the inappropriate use of drugs.
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