Roblek Tina, Deticek Andreja, Leskovar Bostjan, Suskovic Stanislav, Horvat Matej, Belic Ales, Mrhar Ales, Lainscak Mitja
Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia; Lek d.d., Verovskova 57, Ljubljana, Slovenia.
Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia.
Int J Cardiol. 2016 Jan 15;203:647-52. doi: 10.1016/j.ijcard.2015.10.206. Epub 2015 Oct 28.
Incidence of drug-drug interactions (DDIs) increases with complexity of treatment and comorbidities, as in heart failure (HF). This randomized, double-blind study evaluated the intervention of the pharmacist on prevalence of clinically relevant DDIs (NCT01855165).
Patients admitted with HF were screened for clinically relevant DDIs, and randomized to control or intervention. All attending physicians received standard advice about pharmacological therapy; those in the intervention group also received alerts about clinically relevant DDIs. Primary endpoint was DDI at discharge and secondary were re-hospitalization or death during follow-up.
Of 213 patients, 51 (mean age, 79 ± 6 years; male, 47%) showed 66 clinically relevant DDIs and were randomized. For intervention (n=26) versus control (n=25), the number of patients with and the number of DDIs were significantly lower at discharge: 8 vs. 18 and 10 vs. 31; p=0.003 and 0.0049, respectively. Over a 6 month follow-up period, 11 control and 9 intervention patients were re-hospitalized or died (p>0.2 for all). No significant differences were seen between control and intervention for patients with eGFR <60 mL/min/1.73 m(2) (78%) for re-hospitalization or death (10 vs. 7; p=0.74).
Pharmacist intervention significantly reduces the number of patients with clinically relevant DDIs, but not clinical endpoints 6 months from discharge.
药物相互作用（DDIs）的发生率会随着治疗复杂性和合并症的增加而升高，如在心力衰竭（HF）中。这项随机、双盲研究评估了药剂师干预对临床相关药物相互作用发生率的影响（NCT01855165）。
对因心力衰竭入院的患者进行临床相关药物相互作用筛查，并随机分为对照组或干预组。所有主治医生均收到关于药物治疗的标准建议；干预组的医生还收到临床相关药物相互作用的警示。主要终点是出院时的药物相互作用，次要终点是随访期间的再次住院或死亡。
213例患者中，51例（平均年龄79±6岁；男性占47%）出现66例临床相关药物相互作用，并被随机分组。干预组（n = 26）与对照组（n = 25）相比，出院时出现药物相互作用的患者数量及药物相互作用的数量均显著更低：分别为8例对18例以及10例对31例；p值分别为0.003和0.0049。在6个月的随访期内，11例对照组患者和9例干预组患者再次住院或死亡（所有p>0.2）。对于估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²的患者（占78%），对照组和干预组在再次住院或死亡方面无显著差异（10例对7例；p = 0.74）。
药剂师干预可显著减少临床相关药物相互作用患者的数量，但对出院6个月时的临床终点无影响。
