药物相互作用致患者服用华法林期间INR异常升高的处方分析

摘要

Objective:To investigate the utilization of warfarin and provide reference for rational drug use.Methods:By retrospective analysis, the warfarin orders and the number of INR in our hospital were obtained from April 2013 to April 2014. According to 2014 AHA/ACC/HRS guideline for the management of patients with atrial ifbrillation, the target of INR in patients with atrial ifbrillation and valve replacement surgery are 2.5 to 3.5, the INR > 3.5 as outliners and the reasons were analyzed. Results:The number of warfarin orders in our hospital during April 2013 and April 2014 was 41 615 items, the monitoring number of INR was 2134 cases, the unusual high value of INR was 145 cases, excluding the factor of dose adjustment, 43 cases of them were caused by drug interaction. The drug interaction plays an important role in the abnormal rise of INR in patients taking warfarin. Conclusion:Warfarin could be influenced by many drugsin vivo, which may cause the abnormal rise of INR. When we use warfarin in clinic, we should pay attention to drug interactions to ensure the drug safety of patients.%目的:通过对我院华法林的使用情况进行调查分析,为临床合理应用提供参考.方法:采用回顾性分析方法,通过HIS系统调取我院2013年4月– 2014年4月使用华法林患者的全部医嘱,同时调取该时段所有的INR检查指标,根据2014年美国房颤诊疗指南推荐房颤患者和瓣膜置换术后INR目标值为2.5 ~ 3.5,将INR > 3.5作为异常值,并对INR异常的处方进行分析.结果:我院2013年4月– 2014年4月使用华法林患者的全部医嘱共41 615条,其中INR监测2134例,INR异常升高145例,排除药物剂量调整因素,43例怀疑为药物相互作用所致.药物相互作用对患者服用华法林期间INR异常升高有很大的影响.结论:华法林在体内可受多种药物影响出现相互作用并导致INR异常升高.在临床应用华法林时,应关注药物相互作用,保障患者用药安全.