评估结构化药物优化审查对处方模式和处方直接口服抗凝剂 (DOAC) 患者出血风险的影响:差异差异研究
Elizabeth M Camacho1, Olly Butters2, Konstantinos Daras2
1Institute of Population Health, University of Liverpool, Liverpool, UK elizabeth.camacho@liverpool.ac.uk.
BMJ open quality
|November 22, 2025
概括
结构化药物优化审查 (SMORs) 安全地将心房动 (AF) 患者切换到爱多沙班,增加其使用而不增加出血风险. 这些审查提高了直接口服抗凝剂 (DOAC) 的处方质量和患者安全.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床药房 临床药房
- 医疗保健服务研究 医疗服务研究
背景情况:
- 前庭动 (AF) 的管理涉及直接口服抗凝剂 (DOAC).
- 国家指南建议使用特定的DOAC,如edoxaban.
- 优化DOAC处方对于患者的治疗结果和医疗保健效率至关重要.
研究的目的:
- 为了评估实施结构化药物优化审查 (SMORs) 的安全性和有效性,对在DOACs上的AF患者.
- 评估SMORs对药物处方模式的影响,特别是切换到edoxaban.
- 为了确定SMOR是否会增加AF患者出血入院的风险.
主要方法:
- 一个复杂的干预涉及SMORs集成到初级保健电子健康记录与决策支持工具.
- 使用链接的电子健康记录进行双重可靠的差异分析.
- 在干预区域 (塞夫顿) 和比较区域 (利物浦) 之间对处方变化和出血入院的比较.
主要成果:
- 在干预区域,AF患者处方EDOXABAN的比例从19%增加到35%,SMOR与此增加的13%有关.
- 在处方阿皮克萨班的患者中观察到显著的11个百分点的下降.
- 不显著的降低出血入院与接受SMOR有关 (8人每1000人接受的入院减少).
结论:
- 结构化药物优化审查 (SMORs) 是可扩展的,有效的药物切换在大型患者群体.
- 在SMORs的支持下,从apixaban大规模切换到edoxaban,并没有增加AF患者的出血并发症入院率.
- 通过将DOAC的使用与基于价值的建议相协调,SMOR可以提高处方质量,提高患者安全,并可能带来成本节省,而不会损害患者安全.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.0K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.0K
Venous Thrombosis III: Interprofessional Care
254
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
254
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
1.0K
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
1.0K
Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.6K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.6K
Therapeutic Drug Monitoring: Affecting Factors
163
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
163
Pharmacovigilance
1.6K
Post-marketing surveillance is a critical component of pharmaceutical regulation, often uncovering unanticipated adverse drug reactions (ADRs) once a drug is widely used over an extended period.
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
1.6K


