新型冠狀病毒感染病患之抗凝血藥物使用分析

Anticoagulants Use Patterns Among Hospitalized Patients with COVID-19 in A Regional Teaching Hospital During the Pandemic

林恬睿(Tein-Jui Lin) ； 林庭宇(Ting-Yu Lin) ； 林育如(Yu-Ju Lin) ； 吳淑娟(Shu-Chuan Wu)

《內科學誌》 33卷3期 (2022/06) Pp. 218-226

https://doi.org/10.6314/JIMT.202206_33(3).05

摘要

新型冠狀病毒疾病（Coronavirus Disease-2019, COVID-19）為嚴重急性呼吸系統綜合症冠狀病毒2（Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2）造成之傳染病，於2021年5月起於台灣大流行。有鑑於國內對於抗凝血藥物的使用利弊尚未有確切定論，且目前未見相關用藥評估與病例分析之文獻，故本研究針對台北市某區域教學醫院COVID-19確診個案，進行抗凝血藥物使用評估以及病例資料分析。研究以回溯性病歷分析進行，根據行政院衛生福利部疾病管制署公布之《新型冠狀病毒SARS-CoV-2感染臨床處置暫行指引第十三版》建議之預期重症項目，蒐集基本資料、慢性病史、危險因子、抗凝血藥物與併發症，以及病人的解隔時間與死亡率，並針對以上資料進行記錄與分析。研究資料以描述性統計、獨立樣本t檢定及卡方檢定進行統計分析，探討相關重要因子並分析病人族群特性，並蒐集藥師介入與評估成效，研究介入情形與病人預後。本研究發現在收治之確診個案族群中，高齡、高血壓與糖尿病三項共病危險因子和病患的死亡率與抗凝血藥物的使用顯著相關，而併發症與糖尿病則與使用抗凝血藥物後的死亡率有較高的關聯。此外，本研究中藥師對於病人的追蹤評估率為100%，藥物治療問題解決率亦為100%，期望本研究結果能提供醫療團隊參考，以期為病人帶來更好的照護品質。

關鍵字

新型冠狀病毒疾病（Coronavirus Disease-2019, COVID-19） ； 抗凝血藥物（Anticoagulants）

並列摘要

Covid-19 is associated with a higher risk of thrombotic complications, and prophylactic dose anticoagulants are recommended for hospitalized nonpregnant patients by international treatment guidelines. Whether the benefit and efficacy of using anticoagulants among Taiwanese patients remains uncertain, we aimed to evaluate the use of anticoagulants and to investigate the risk factors of the patients. 144 patients with confirmed SARSCoV-2 infection were admitted to a regional teaching hospital in Taipei, Taiwan between May, 2021 and July, 2021. We retrospectively collected these patients' data from electronic medical records. Descriptive statistics, independent t-test and Chi-square were applied for patients' characteristics and important factors. Medication use evaluation was performed through SOAP format for every patient by dedicated pharmacists. There were 29% patients receiving anticoagulants, 90% of the use were for Covid-19 thromboprophylaxis. Among these patients, old age, hypertension and diabetes have a high correlation with mortality and the use of anticoagulants. There was no medication related problem that remains unresolved, all patients were completely assessed.