| Objectives: Clinical pharmacists provide systematic pharmaceutical care for anticoagulants based on warfarin gene testing to explore the effects of pharmacological monitoring on anticoagulant awareness,anticoagulant efficacy,anticoagulant safety and compliance.To further guide the clinical precision rationalization of drug use to provide reference.Methods: In this study,127 patients who took warfarin for the first time during hospitalization from July 2019 to December 2020 or whose INR value was less than1.5 for the first time after admission and who continued anticoagulation therapy for more than 3 months after discharge were the subjects of the study.Among them,there were 65 cases in the control group and 62 cases in the intervention group.The control group adopted the traditional method of administration,and the doctor is responsible for the formulation and implementation of the anticoagulation treatment plan for the cases in this group.The clinical pharmacist will not provide any pharmaceutical services.The intervention group adopted genetic testing,and the clinical pharmacist monitored the medication throughout the entire process.The two groups of patients were followed up regularly after discharge(1 month,2 months,3 months after discharge).And according to the anticoagulation treatment service content received at different time points,the effect evaluation is carried out.Results:1.General clinical data comparison The average age of the intervention group and the control group was(61.10±12.69)years old and(67.12±10.81)years old,and the difference was statistically significant(P<0.05).But other than that,there was no significant difference in other clinical data between the two groups(P>0.05).2.Analysis of genetic test results The Hardy-Weinberg genetic balance test suggested that the CYP2C9(1075A>C)and VKORC1(1639 G>A)gene frequencies of 62 patients in the intervention group conformed to the Hardy-Weinberg genetic balance law,which was representative of the population(P>0.05).Among them,patients with CYP2C9(1075A>C)*1/*1genotype had significantly higher warfarin dose requirements than those with *1/*3genotype(P<0.05);while patients with VKORC1(1639 G> A)The recommended dose for patients with AA genotype was significantly lower than that for patients with AG and GG genotypes,and the difference was statistically significant(P<0.05).In addition,the effect of different genotype combinations on the recommended dose of warfarin was also significant(P<0.05).3.Evaluation of awareness of anticoagulation knowledge Compared with the control group,the patients in the intervention group had a higher average score on the anticoagulation questionnaire [(8.74±0.77)VS(6.15±1.33)],and the difference was statistically significant(P<0.01).In addition,the cognition level of patients who were included in the intervention group and received anticoagulation therapy was significantly better than that of the control group,and there were also significant differences between the groups(P<0.01).4.Evaluation of anticoagulant efficacy The anticoagulation rate of patients in the intervention group during hospitalization and during out-of-hospital follow-up were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).In order to further clarify the trend of the INR value over time,we compared and analyzed the average level of the INR value at different time points and the compliance status.The results showed that the INR values of the intervention group and the control group were(1.98±0.61)and(1.77±0.54),the proportion of people meeting the standard at the corresponding time point was 43.55% and 24.62%,there was significant difference between groups(P<0.05).After the two groups of patients were discharged from the hospital,the INR monitoring value and INR compliance rate were statistically significant in other time periods except the second month(P<0.05).And compared with the control group,the intervention group had better anticoagulation quality,and the comparison between the groups was also significantly different(P<0.05).5.Anticoagulation safety evaluation In this study,the total incidence of adverse events in the intervention group was significantly lower than that in the control group(P<0.05),regardless of whether it was during hospitalization or during out-of-hospital follow-up.6.Evaluation of anticoagulation compliance The Morisky compliance scores of the two groups were(7.23±0.75)points and(6.98±0.74)points at 1 month after discharge from the hospital,and the difference was not statistically significant(P>0.05).Continue to monitor them closely and we found that at the second and third months after discharge,the MMAS-8 scores of the intervention group were significantly higher than those of the control group,and the difference was statistically significant(t values were respectively 2.032 and 3.320,P<0.05).Conclusions: In this study,clinical pharmacy services were taken as the entry point,and the combination of drug genetic testing and anticoagulation treatment services was adopted to implement a full-process systemic medication monitoring for anticoagulant treatment of oral warfarin.And a series of pharmaceutical services such as pharmacy rounds,drug use education,drug consultation,adverse reaction monitoring,and out-of-hospital follow-up are run through the entire anticoagulation treatment process.This management model can effectively improve patients’ understanding of anticoagulation knowledge,significantly improve the effectiveness and compliance of patients with anticoagulation therapy,and reduce the risk of adverse events.Therefore,the participation of clinical pharmacists in warfarin anticoagulation therapy has an important impact on promoting the reasonable and standardized clinical use of this drug. |
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