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題名 | 關節置換術後抗血栓藥使用評估=Evaluation on the Use of Antithrombotic Agents after Total Hip and Total Knee Replacement Surgery |
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作者 | 林美吟; 張瓊月; 劉致宏; | 書刊名 | 藥學雜誌 |
卷期 | 30:4=121 2014.12[民103.12] |
頁次 | 頁137-143 |
分類號 | 416.61、416.61 |
關鍵詞 | 人工關節置換術; 深部靜脈栓塞; 抗血栓藥品; |
語文 | 中文(Chinese) |
中文摘要 | 靜脈栓塞是最常見的關節置換手術後併發症,根據美國胸腔科醫學會 (ACCP) 建議,對於接受關節置換手術的病人使用抗血栓藥預防治療,可以有效減低深層靜 脈栓塞的發生率,本研究目的在於評估抗凝血藥 rivaroxaban (Xarelto) 及 tinzaparin (Innohep) 用於人工關節置換術後深部靜脈血栓 (DVT) 預防的療效與安全性。 本研究以回溯性方式評估南部某地區醫院,接受人工關節置換手術的病人,包括 膝關節及髖關節手術。收集101年2月至102年1月使用 Innohep 治療的病人及102年2月 至103年1月使用 Xarelto 治療的病人,評估藥品用法及療程是否適當,並且從病歷中 收集資料,比較兩組預防 DVT 的療效與安全性。 本研究共收納128位接受人工關節置換術的病人,結果顯示 Innohep 組 (n = 64) 有8位發生 DVT,發生率為12.5%,Xarelto 組 (n = 64) 有7位發生 DVT,發生率為 10.9%。另外分析 DVT 平均發生的天數及發生 DVT 後使用 warfarin 治療的結果,結 果顯示兩組術後平均第11.7天發生 DVT,使用 warfarin 平均治療天數為14.9天,研究 期間無發生嚴重出血反應。評估 Innohep 及 Xarelto 使用的適當性,研究發現劑量及 療程皆低於臨床建議。 根據本研究結果顯示,使用 Innohep 或 Xarelto 於人工關節置換術靜脈血栓預防, 其 DVT 的發生率相當,此外抗凝血藥的用法及療程皆低於臨床建議。因此,希望 藉由藥師主動介入與醫師制定新的治療準則後,長期追蹤評估,以期可以有效降低 DVT 的發生。 |
英文摘要 | Venous thromboembolism is a common and serious complication after total hip or knee replacement surgery. According to the recommendations of American College of Chest Physicians, incidence of deep vein thrombosis (DVT) is lowered in those patients who are given prophylactic antithrombotics after arthroplasty surgery. The aim of this study was to evaluate the efficacy and safety in using tinzaparin (Innohep) or rivaroxaban (Xarelto) for thromboprophylaxis after arthroplasty surgery. This is a retrospective study conducted on patients with total hip or knee replacement in a regional hospital in southern Taiwan. Medical records were collected from patients who received Innohep during February 2012 to January 2013, and from patients who received Xarelto during January 2013 to February 2014. Treatment efficacy and safety profiles on the utilization of antithrombotic agents for preventing DVT were analyzed. The study included 128 patients who were hospitalized for knee or hip replacement. The incidence of DVT occurred in 8 (12.5%) of 64 patients given Innohep and in 7 (10.9%) of 64 patients given Xarelto. Average days of DVT occurrence and warfarin therapy received for both groups were 11.7 days and 14.7 days, respectively. No serious bleeding events were observed during the study periods. Both treatment dose and required duration of anticoagulants were below clinical recommendations, suggesting the treatment course of Innohep or Xarelto were both appropriate among the patients. In summary, no significant difference on DVT incidence was observed in patients received Innohep or Xarelto after total knee or hip replacement surgery. The use of antithrombotics and treatment duration are lower than clinical recommendations. Therefore, we hope the incidence of DVT could be effectively reduced by the active involvement of pharmacists and physicians for developing new treatment guidelines and continuous longterm assessment. |
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