Pharmacy Branka Marušić, Trg Ante Starčevića 24, 31450, Donji Miholjac, Croatia.
Hematology Department, University Hospital Dubrava, Avenija Gojka Suska 6, 10000, Zagreb, Croatia.
Int J Clin Pharm. 2019 Oct;41(5):1166-1173. doi: 10.1007/s11096-019-00894-4. Epub 2019 Sep 7.
Background Adverse reactions to warfarin may be serious and can lead to hospitalisation or death. Minimising the risk of adverse drug reactions through the intervention of community pharmacists is important for patients receiving warfarin, especially for elderly (≥ 65 years) patients living in rural areas. Objective To evaluate the impact of an intervention by community pharmacists on the risk of adverse drug reactions in elderly rural patients receiving warfarin. Setting: A community pharmacy in a rural area of Croatia. Method We conducted a prospective randomised trial. Eligible patients were recruited at the pharmacy and randomised into one of two groups. The participants were followed up every month for 6 months. Main outcome measure: The incidence and type of adverse drug reactions caused by warfarin and the time-to-event. Results In total, 140 patients were randomized and 131 patients completed the study; 65 patients were in the intervention group. The median age of patients was 73 years of age. The cumulative incidence of adverse drug reactions was significantly lower in the intervention group (6-months rate 29% vs. 85% for intervention and control, respectively; hazard ratio = 0.17, p < 0.001) than in the control group. Factors multivariately associated with the development of adverse drug reactions related to warfarin (p < 0.05) were the absence of pharmaceutical intervention, higher time in therapeutic range, change of warfarin dose, changes in dietary vitamin K intake, and marital status other than married. Conclusion Overall, the pharmacist's intervention significantly prolonged the time to occurrence of adverse drug reactions and reduced their incidence.
华法林的不良反应可能很严重，并可能导致住院或死亡。通过社区药剂师的干预，最大限度地减少接受华法林治疗的患者发生药物不良反应的风险非常重要，尤其是对于居住在农村地区的老年（≥65 岁）患者。目的：评估社区药剂师的干预措施对华法林治疗的农村老年患者药物不良反应风险的影响。地点：克罗地亚农村地区的一家社区药房。方法：我们进行了一项前瞻性随机试验。在药房招募符合条件的患者并将其随机分为两组。对参与者进行了为期 6 个月的每月随访。主要观察指标：华法林引起的药物不良反应的发生率和类型以及事件时间。结果：共招募了 140 名患者，其中 131 名患者完成了研究；65 名患者在干预组。患者的中位年龄为 73 岁。干预组的药物不良反应累积发生率明显低于对照组（6 个月发生率分别为 29%和 85%；风险比=0.17，p<0.001）。与华法林相关药物不良反应发生多因素相关（p<0.05）的因素包括无药物干预、治疗范围内时间更长、华法林剂量变化、饮食中维生素 K 摄入量变化和非已婚婚姻状况。结论：总体而言，药剂师的干预显著延长了药物不良反应发生的时间，并降低了其发生率。
