Study On The Effect Of Pharmacist Intervention On Oral Anticoagulant In Patients With Atrial Fibrillation

Part 1 Effect of pharmacist intervention on warfarin in patients with atrial fibrillationObjective:Through the pharmaceutical care of atrial fibrillation patients who were hospitalized with warfarin in a hospital,the effects of anti-coagulation efficacy,safety and compliance on atrial fibrillation patients were investigated.for reference.Methods:Patients with atrial fibrillation who took warfarin from January 2017 to March 2018 in a top three hospital were randomly divided into study group and control group.In the control group,doctors and nurses were responsible for the implementation of the warfarin anticoagulation program.On the basis of the control group,the pharmacist participated in the implementation of anticoagulant therapy for patients with atrial fibrillation and conducted individualized pharmaceutical care.The international normalized ratio?INR?changes,the time in therapeutic range?TTR?of the INR in the treatment range?2.0-3.0?,and the TTR?58%were analyzed before and after the hospitalization.The proportion of the evaluation of the effectiveness of warfarin anticoagulant therapy.The Morisky Medication Adherence Scale-8?MMAS-8?was used to evaluate changes in compliance between the two groups.The safety of the two groups of patients was evaluated using the incidence of adverse events.Results:1.There were 53 cases in the control group and the study group.The average age,gender,education level,proportion of patients with hepatic insufficiency,proportion of patients with renal insufficiency,and combined disease were not statistically significant?P>0.05?.The two groups of patients with a higher CHA₂DS₂-VASc score?2?high risk of embolization?,accounting for 87.73%.2.There were no significant differences in the INR,TTR,and TTR?58%between the two groups?P>0.05?.However,the proportion of patients with INR,TTR,and TTR?58%increased in the study group six months after discharge.The difference was statistically significant?P<0.05?.3.There was no significant difference in Morisky score between the two groups before admission.However,the Morisky scores of the two groups were higher than those before the six months after discharge,and the difference was statistically significant?P<0.05?.The Morisky score of the control group was lower than that of the study group six months after discharge,and the difference was statistically significant?P<0.05?.4.The total incidence of adverse events in the study group was 20.75%,and the total incidence of adverse events in the control group was 39.62%.The incidence of adverse events in the study group was lower than that in the control group,and the difference was statistically significant?P<0.05?.Conclusion:The pharmacist's participation in the pharmaceutical care of warfarin anticoagulant therapy can help to improve the efficacy,safety and compliance of anticoagulation in patients with atrial fibrillation.Part 2 Effect of pharmacist intervention on warfarin or rivaroxaban in patients with atrial fibrillationObjective: To compare the safety and efficacy of oral rivaroxaban and warfarin in patients with atrial fibrillation in a top three hospital,and to explore the influencing factors of compliance in patients with atrial fibrillation.Methods: Seventy patients with atrial fibrillation who were discharged from rivaroxaban or warfarin from March 2017 to September 2018 in a top three hospital were selected and divided into study group and control group by random number table,with 35 cases in each group.The pharmacist participated in the management of anticoagulant therapy in patients with atrial fibrillation and conducted pharmaceutical care.The research group took rivaroxaban anticoagulation and the control group took warfarin anticoagulation.Compare the effects of the two drugs on patients with liver or kidney dysfunction and the changes of coagulation function indexes such as prothrombin time?PT?and INR.MMAS-8 was used to investigate the compliance of the two groups of patients taking oral anticoagulant drugs,and to analyze the factors affecting the compliance of patients with atrial fibrillation.Results: 1.The warfarin and rivaroxaban groups each included 35 patients.The hospital stay in the rivaroxaban group was longer than that in the warfarin group,and the difference was statistically significant?P<0.05?.In addition,the general clinical data of the two groups of patients were not statistically significant?P>0.05?.2.Comparing the effects of rivaroxaban and warfarin on patients with liver or kidney dysfunction,there was no significant difference between the two groups?P>0.05?.3.The prothrombin time was compared between the rivaroxaban group and the warfarin group.The prothrombin time in the rivaroxaban group was longer than that in the warfarin group.The difference was statistically significant?P<0.05?.However,the INR values of the two groups were comparable,and the difference was not statistically significant?P>0.05?.4.Age and literacy were the influencing factors of patients taking anticoagulant medication compliance?P<0.05?.Conclusion: The two drugs have certain safety to liver and kidney function,and the anticoagulant treatment effect of oral rivaroxaban is better than warfarin.Age and literacy are factors influencing patients' compliance with anticoagulant drugs.It may be more difficult for older and less educated patients to acquire and understand anticoagulant medications.Pharmacists should strengthen medication education and patient communication.