Background: Middle-aged and elderly patients face an elevated risk of postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG), a complication that worsens prognosis. While off-pump CABG (OPCABG) reduces some injury mechanisms, no prediction model has been developed for predicting POCD in this surgical population. This study aimed to develop a predictive model for POCD following OPCABG to facilitate the earlier and more precise identification of high-risk patients. Methods: This prospective single-center study enrolled 412 patients who underwent elective OPCABG at Beijing Anzhen Hospital between March 2024 and March 2025. Patients were randomly allocated in a 7:3 ratio to a training set (n=288) and a testing set (n=124). Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression on the training set. A nomogram was subsequently developed using the chosen variables. The predictive performance of the model was assessed in both sets using the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, calibration curves, and decision curve analysis (DCA). Results: POCD was observed in 174 out of 412 patients (42.2%). Predictive factors included age, body mass index (BMI), blood glucose, total cholesterol (TC), smoking history, and history of prior silent cerebrovascular disease (SCVD). The model demonstrated good diagnostic performance, with area under the curve (AUC) values of 0.722 [95% confidence interval (CI): 0.663-0.780] in the training set and 0.704 (95% CI: 0.609-0.800) in the testing set. Calibration curves showed close agreement between the predictions of the nomogram and the observed outcomes. DCA for both datasets suggested favorable clinical utility of the model. Conclusions: This study presents a LASSO-derived predictive model for the estimation of the risk of POCD in patients undergoing OPCABG.

Capsaicin, a transient receptor potential vanilloid 1 (TRPV1) agonist, is used topically for neuropathic pain. Its minimal systemic absorption necessitates highly sensitive quantification methods to accurately assess systemic exposure. This study aimed to develop and validate a simple, rapid, and highly sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of capsaicin in human plasma. Plasma samples (50 μL) were prepared by a simple protein precipitation using acetonitrile, with capsaicin-d3 as the internal standard (IS). Chromatographic separation was performed on a Waters Xbridge C18 column (2.1 × 50 mm, 3.5 μm) with a 3-min gradient elution using 1% formic acid in water and acetonitrile. Detection was conducted on a triple quadrupole tandem mass spectrometer in positive electrospray ionization (ESI) mode, utilizing multiple-reaction monitoring (MRM). The assay was validated over the linear range of 0.05-50 ng/mL. The method demonstrated excellent precision (CV% ≤ 11.62%) and accuracy (RE% within ±13.60%), with high recovery (>95%). Stability was confirmed under various conditions relevant to clinical sample handling. The validated method was successfully applied to a pharmacokinetic study involving 24 patients with knee osteoarthritis receiving a topical capsaicin liniment, demonstrating its suitability for clinical applications.

Whereas our previous single-dose study characterized the distinct pharmacokinetic (PK) profile of enteric-coated sustained-release (ECSR) aspirin compared with enteric-coated (EC) aspirin, featuring prolonged absorption and reduced variability, its pharmacodynamic (PD) effects under multiple-dose conditions remain unknown. This study was designed to compare the multiple-dose PK and PD profiles of 50 mg ECSR aspirin versus 100 mg EC aspirin. An open-label, randomized, two-sequence, crossover study was conducted in 12 healthy Chinese male subjects. Participants received either 100 mg EC or 50 mg ECSR aspirin daily for 10 consecutive days. PK parameters and PD biomarkers, including serum thromboxane B2 (TXB2), urinary 11-dehydro-thromboxane B2 (11-dehydro-TXB2) and 2,3-dinor-6-keto prostaglandin F1α (2,3-dinor-6-keto PGF1α), were assessed. PK analysis revealed that dose-normalized systemic exposure to the parent drug (acetylsalicylic acid, ASA) for the ECSR formulation was only 37

OBJECTIVE:This study aimed to identify risk factors associated with mitral annular calcification (MAC) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to evaluate its relationship with clinical outcomes. METHODS:A total of 310 patients with HOCM who underwent interventricular septal myectomy were retrospectively analyzed. Patients were divided into a MAC group (n = 24) and a non-MAC group (n = 286). Demographic characteristics, echocardiographic parameters, and clinical data were compared between groups. Major adverse cardiovascular and cerebrovascular event (MACCE) and circulating levels of brain natriuretic peptide, Apelin, and Galectin-3 were analyzed. RESULTS:Patients with MAC were older and showed higher prevalence of aortic annular calcification, mitral leaflet thickening, and moderate-to-severe tricuspid regurgitation (P < 0.05). Multivariate analysis identified gender, age, aortic annular calcification, moderate-to-severe tricuspid regurgitation, and mitral leaflet thickening as independent risk factors for MAC. Patients with MAC showed larger left ventricular end-diastolic volume, reduced left ventricular ejection fraction, and greater left atrium mass, and a higher incidence of MACCE than those without MAC (P < 0.05). CONCLUSION:In HOCM undergoing septal myectomy, MAC is associated with adverse cardiac remodeling and unfavorable clinical outcomes. Identification of related factors may aid risk stratification and perioperative management.

Hypertrophic obstructive cardiomyopathy (HOCM) is a well-recognized inherited cardiac disease. This study was conducted to explore the role of lncRNA ADAMTS9 antisense RNA 1 (ADAMTS9-AS1) in HOCM-induced cardiomyocyte hypertrophy. The serum of HOCM patients was collected. AC16 cells were treated with isoproterenol (ISO) and transfected with oe-ADAMTS9-AS1 vector, miR-185-5p mimic, and lysine acetyltransferase 7 (KAT7) specific small interfering RNA. lncRNA ADAMTS9-AS1, miR-185-5p, KAT7, brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) in the serum or cells were determine by qRT-PCR or Western blot assay. Cell surface area was observed by Texas Red-Phalloidin staining. Subcellular localization of lncRNA ADAMTS9-AS1 was tested by nuclear/cytoplasmic fractionation assay, with RNA pull-down and dual-luciferase assay to validate gene interactions. lncRNA ADAMTS9-AS1 was downregulated in the serum of HOCM patients and ISO-treated AC16 cells. lncRNA ADAMTS9-AS1 overexpression inhibited ISO-induced cardiomyocyte hypertrophy and reduced levels of ANP and BNP. lncRNA ADAMTS9- AS1 was located in cytoplasm and inhibited miR-185-5p expression through targeted binding. miR-185-5p bound to KAT7 3’UTR and inhibited KAT7 expression. miR-185-5p overexpression and KAT7 knockdown both neutralized the inhibitory role of lncRNA ADAMTS9-AS1 in cardiomyocyte hypertrophy. Overall, lncRNA ADAMTS9-AS competitively bound to miR-185-5p to up-regulate KAT7 and thus inhibited cardiomyocyte hypertrophy.

ObjectivesAims to compare the contemporary and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with advanced chronic kidney disease (CKD).Methods823 CAD patients with advanced CKD (eGFR < 30 ml/min/1.73 m2) were collected, including 247 patients who underwent CABG and 576 patients received PCI from January 2014 to February 2021. The primary endpoint was all-cause death. The secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), stroke and revascularization.ResultsMultivariable Cox regression models were used and propensity score matching (PSM) was also performed. After PSM, the 30-day mortality rate in the CABG group was higher than that in the PCI group but without statistically significant (6.6% vs. 2.4%, p = 0.24). During the first year, patients referred for CABG had a hazard ratio (HR) of 1.42 [95% confidence interval (CI), 0.41–3.01] for mortality compared with PCI. At the end of the 5-year follow-up, CABG group had a HR of 0.58 (95%CI, 0.38–0.86) for repeat revascularization, a HR of 0.77 (95%CI, 0.52–1.14) for survival rate and a HR of 0.88(95%CI, 0.56–1.18) for MACCEs as compared to PCI.ConclusionsAmong patients with CAD and advanced CKD who underwent CABG or PCI, the all-cause mortality and MACCEs were comparable between the two groups in 30 days, 1-year and 5 years. However, CABG was only associated with a significantly lower risk for repeat revascularization compared with PCI at 5 years follow-up.

Purpose: To study and compare the pharmacokinetic characteristics of enteric-coated sustained-release (EcSr) aspirin tablets with enteric-coated (Ec) aspirin tablets (Bayer S.p.A) in healthy Chinese participants.Patients and Methods: In this open, randomized, single-dose, three-way, crossover study, 18 healthy participants randomly received 100 mg EcSr tablets pre-prandially (a.c.), EcSr tablets post-prandially (p.c.), or Ec tablets a.c. in each period. The concentrations of acetylsalicylic acid (ASA) and salicylic acid (SA) in plasma were determined by the LC-MS/MS method, and the pharmacokinetic parameters were calculated using WinNonlin (version 8.1).Results: The essential PK parameters under the three treatment conditions (ie Ec a.c., EcSr a.c. and EcSr p.c.) were as follows: Cmax, ASA: 758.38 & PLUSMN;455.34, 222.77 & PLUSMN;98.04 and 194.54 & PLUSMN;61.19 ng, Tmax, ASA: 6.75(2,16), 4.5(2,11) and 8.25(5,11) h, T1/2, ASA: 0.43 & PLUSMN;0.08, 1.44 & PLUSMN;0.59 and 4.32 & PLUSMN;10.04 h, AUC0-t, ASA: 1008.88 & PLUSMN;452.27, 918.04 & PLUSMN;238.40 and 845.55 & PLUSMN;183.25 h & BULL;ng/mL; Cmax, SA: 6409.38 & PLUSMN;2098.52, 2863.53 & PLUSMN;679.73 and 2913.75 & PLUSMN;853.27ng/mL, Tmax, SA: 7.25(2,24), 10(3.5-14) and 10(7,14) h, T1/2, SA: 2.21 & PLUSMN;0.46, 2.69 & PLUSMN;0.72 and 3.51 & PLUSMN;2.06h, AUC0-t, SA: 29,131.41 & PLUSMN;9376.23, 27,243.97 & PLUSMN;7465.16, 27,240.25 & PLUSMN;7444.67 h & BULL;ng/mL. When taking EcSr aspirin tablets, the 90% confidence intervals of the geometric mean ratios (pre-prandial/post-prandial) of AUC0-t, ASA and AUC0-& INFIN;, ASA, Cmax, SA, AUC0-t, SA and AUC0-& INFIN;, SA were within the range of 80.00%-125.00%.Conclusion: EcSr aspirin tablets showed less inter-individual variation in release and absorption than Ec aspirin tablets, which was well reflected by comparing essential PK parameters. Furthermore, meals had no significant effect on the pharmacokinetics of EcSr aspirin tablets.

目的:为完善我国临床试验用药品管理的法规及相关要求提供参考与借鉴.方法:比较国内外临床试验中试验用药品的法规、指南及相关要求的异同点,并以"临床试验""药品管理""pharmacy-based investigational drug service"等为关键词或主题词,查询中国知网、万方数据、PubMed、OVID等数据库中近年文献,结合我国目前试验用药品的管理现状,对比分析国内外管理差异.结果 与结论:可通过借鉴美国临床试验质量管理规范(Good Clinical Practice,GCP)、欧盟GCP、人用药品注册技术要求国际协调会议(The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use,ICH)GCP等相关法规及美国卫生系统药师协会(American Society of Health System Pharmacists,ASHP)和英国皇家医药学会(Royal Pharmaceutical Society of Britain,RPS)试验用药品管理相关指南,在结合我国国情并遵循GCP及相关法规的基础上,逐步建立并完善成本预算评估制度及相关标准操作规程(Standard Operating Procedures,SOP),从而促进临床试验质量的进一步提升.

前不久,门诊来了一位76岁的老奶奶,她因腰腿痛诊断为"老年性骨质疏松症",医生为其开出了碳酸钙片、骨化三醇软胶囊.患者回家后,听朋友说骨质疏松不仅需要补钙,还需要补充维生素D,于是特意来咨询,问需不需要再开些维生素D.

目的 探讨急性冠状动脉综合征(ACS)患者合并心房颤动的相关因素及抗凝治疗情况.方法 纳入2018年1月至2020年2月首都医科大学附属北京安贞医院诊断为ACS的患者46 556例,根据是否诊断为心房颤动分为合并心房颤动患者(心房颤动组)和未合并心房颤动患者(对照组).比较2组临床资料,分析ACS患者合并心房颤动的影响因素.分析ACS合并心房颤动患者的抗凝治疗情况.结果 46 556例患者中心房颤动组1 353例(2.9％),对照组45 203例(97.1％).多因素分析结果显示,年龄、高血压、脑梗死、甲状腺功能异常、体重指数、血小板计数、D-二聚体、左心室舒张末期内径、E波最大流速、A波最大流速是ACS患者合并心房颤动的独立影响因素(均P＜0.05),其中年龄是ACS患者合并心房颤动的最强相关因素.合并心房颤动的ACS患者中,仅有30.7％(415/1 353)启动了抗凝治疗,其余69.3％(938/1 353)的患者仅使用抗血小板治疗或未使用任何抗凝或抗血小板药物.结论 年龄是ACS患者合并心房颤动的最强相关因素.ACS合并心房颤动患者抗凝治疗仍处于十分不足的状态.

Objectives To compare the long-term outcomes of coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for coronary artery disease (CAD) patients with chronic kidney disease (CKD). Methods Coronary artery disease patients with decreased kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) who underwent CABG (n = 533) or PCI with DES (n = 952) from 2013 to 2020 were enrolled at a single center. The baseline characteristics and clinical outcomes were compared between the CABG and PCI groups for each matched pair of patients with CKD. The primary endpoint was the occurrence of all-cause death. The secondary endpoints were major adverse cardiovascular events (MACCEs) such as death, myocardial infarction (MI), stroke, and repeat revascularization. Results A total of 1,485 patients underwent revascularization, such as 533 CABG and 952 patients with PCI. The median follow-up duration was 55.6 months (interquartile range 34.3–74.7 months). Multivariable Cox regression models were used for risk adjustment, and after propensity score matching (PSM), 399 patients were well matched in each group. The in-hospital mortality rate in the CABG group was higher than that in the PCI group, but the difference was not statistically significant (5.0 vs. 2.5%, p = 0.063). At the 1-year follow-up, CABG was associated with a lower survival rate than PCI (94.2 vs. 98.0%, hazard ratio [HR] of 3.72, 95% CI = 1.63–8.49, p < 0.01). At the end of the 5-year follow-up, the freedom from MI and the freedom from repeated revascularization were both better in the CABG group compared to the PCI group (89.1 vs. 81.7%, HR of 0.59, 95% CI = 0.38–0.92, p = 0.019; 86.9 vs. 73.8%, HR of 0.54, 95% CI = 0.36–0.81, p = 0.003, respectively). Furthermore, the freedom from MACCEs was also better in the patients of CABG compared with the patients of PCI (58.5 vs. 51.3%, HR of 0.71, 95% CI = 0.55–0.91, p = 0.030). CABG had a higher cumulative survival rate (68.4 vs. 66.0%) but without a statistically significant difference (HR of 0.92, 95% CI = 0.67–1.27, p = 0.602) compared with that of PCI. Conclusions Compared to the use of PCI with a drug-eluting stent among patients with CKD, the use of CABG was associated with a lower MI rate, repeat revascularization rate, and lower number of MACCEs during the long-term follow-up. At a follow-up of 1 year, the number of MACCEs and other adverse events were comparable between the two cohorts, but CABG showed a lower survival rate than PCI.

BACKGROUND Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with significant morbidity and mortality. This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population. METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression analysis was used to determine the independent predictors of AKI, and the predictive ability of the model was determined using a receiver operating characteristic (ROC) curve. RESULTS The incidence of cardiac surgery–associated acute kidney injury (CSA-AKI) was 24.17%, and 0.53% of AKI patients required dialysis (AKI-D). Among the derivation cohort, multivariable logistic regression showed that age ≥ 70 years, body mass index (BMI) ≥ 25 kg/m2, estimated glomerular filtration rate (eGFR) ≤ 60 mL/min per 1.73 m2, ejection fraction (EF) ≤ 45%, use of statins, red blood cell transfusion, use of adrenaline, intra-aortic balloon pump (IABP) implantation, postoperative low cardiac output syndrome (LCOS) and reoperation for bleeding were independent predictors. The predictive model was scored from 0 to 32 points with three risk categories. The AKI frequencies were as follows: 0−8 points (15.9%), 9−17points (36.5%) and ≥ 18 points (90.4%). The area under of the ROC curve was 0.730 (95% CI: 0.691−0.768) in the derivation cohort. The predictive index had good discrimination in the validation cohort, with an area under the curve of 0.735 (95% CI: 0.655−0.815). The model was well calibrated according to the Hosmer-Lemeshow test (P = 0.372). CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients, and could improve the early prognosis and clinical interventions.

目的 确定《P2Y12受体拮抗剂用于急性冠状动脉综合征或经皮冠状动脉介入治疗患者精准治疗快速建议指南》(简称指南)纳入的临床问题和结局指标.方法 通过专家咨询、文献检索起草拟纳入临床问题与结局指标初稿,并征询一线医师和药师意见.最终,由指导委员会确定16个临床问题和19个结局指标在专家会上采取德尔菲法调查.通过积极系数、变异系数进行质量控制.结果 专家在会议上补充2个临床问题和3个结局指标.最终,共有13个临床问题必须形成推荐意见或说明,5个临床问题需根据证据质量与专家共识决定是否形成推荐意见,形成15个关键结局与7个重要结局.研究中专家积极程度高,积极系数为100％,变异系数经第2轮匿名反馈后有所降低,专家的意见趋于一致.结论 通过3轮德尔菲法调查确定纳入的临床问题与结局指标,为指南的后续制定奠定了良好的基础.

BACKGROUND:The rapid and accurate discrimination of colorectal carcinoma (CRC) and polyps at the molecular level enables early intervention of CRC, which can greatly improve the 5-year survival rate of patients. Here we reported the potential of conductive polymer spray ionization mass spectrometry (CPSI-MS) in successfully screening CRC according to the serum metabolic profile. METHODS:Trace intravenous blood (50 μL) was collected from 60 colorectal carcinoma (CRC) and 60 polyp patients, respectively. After centrifugation, serum (2 μL) was loaded onto the tip of conductive polymer to form a dried serum spot. When the 5 μL methanol-water (1:1, v/v) extraction solvent was spiked onto the dried serum spot followed with +4.5 kV high voltage applied on the polymer tip, the extracted components will be ionized and carried into the MS system for direct metabolic profiling. FINDINGS:There were 51 metabolites discovered to be significantly changed in CRC serum compared to polyps. Combining these metabolites as the characteristic panel, the ideal diagnostic performance was achieved by Lasso regression model with the accuracy of 88.3%. INTERPRETATION:This pilot study demonstrated the potential of CPSI-MS as a cost-effective tool in large-scale CRC screening in the high-risk population.

Atherosclerosis (AS) is one of the most severe cardio-vascular diseases involved in the phenotypic switching of vascular smooth muscle cells (VSMCs). Tryptanthrin is a natural product with broad biological activities. However, the effect of tryptanthrin on atherosclerotic progression is unclear. The aim of this study was to determine the role of tryptanthrin in AS and explore the potential mechanism. In vitro, primary VSMCs were stimulated with platelet-derived growth factor-BB (PDGF) to induce cell dedifferentiation. Treatment with tryptanthrin (5 mu M or 10 mu M) suppressed the proliferation and recovered the contractility of VSMCs in the presence of PDGF. The contractile proteins (alpha-smooth muscle actin, calponin, and SM22 alpha) were increased, and the synthetic protein vimentin was decreased by tryptanthrin in PDGF-induced VSMCs. ApoE(-/-) mice fed with high-fat diet were used as an in vivo model of AS. Similarly, gavage administration of tryptanthrin (50 mg/kg or 100 mg/kg) attenuated VSMC phenotypic changes from a contractile to a synthetic state in aortic tissues of AS mice. The serum lipid level, atherosclerotic plaque formation, and arterial intimal hyperplasia were attenuated by tryptanthrin Furthermore, tryptanthrin increased the expression levels of phosphorylated AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) both in vitro and in vivo. Administration of compound C, an AMPK inhibitor, reversed the inhibitory effect of tryptanthrin on VSMC dedifferentiation in vitro. Thus, we demonstrate that tryptanthrin protects against AS progression through the inhibition of VSMC switching from a contractile to a pathological synthetic phenotype by the activation of AMPK/ACC pathway. It provides novel insights into AS prevention and treatment.

目的 研究2021年9月30日世界卫生组织出版的2021版《世界卫生组织基本药物标准清单》(以下简称《标准清单》)更新情况,为我国基本药物遴选提供参考.方法 将2021版与2019版《标准清单》进行比对,分析删减和新增药品特点.结果 2021版《标准清单》共列出479种药品,较2019版的459种删减4种、新增24种药品.2021版《标准清单》新增加了牙科制剂大类,纳入更多抗感染药物和抗肿瘤药物、精准治疗的药物、固定剂量复方制剂、吸入药物、长效胰岛素类似物.结论 纳入"新药"一直是《标准清单》更新的趋势,并且2021年版《标准清单》提示精准治疗药物、联合治疗药物和长效疗程药物是未来药物开发的重点方向之一.

为促进人血白蛋白在心脏外科围术期的合理使用,制定一个基于循证医学证据的相关指南已是迫在眉睫.本指南计划书将主要介绍该指南相关制作方法和流程,包括专家组的组建,临床问题的收集及确定,证据的获取、评价以及最终形成推荐意见和共识等.

目的:人血白蛋白广泛用于心脏外科围手术期患者的综合管理中,但国内外缺乏相关指南及共识,课题组严格遵循指南制定规范,制定《心脏外科人血白蛋白合理使用快速建议指南》,旨在促进人血白蛋白的合理使用.方法:项目专家组各位专家通过三轮德尔菲法完成本指南临床问题及结局指标的确定.结果:第一轮共有3个临床问题与14个结局指标达成共识,补充了 6个临床问题与1个结局指标;第三轮有10个临床问题与1个结局指标进一步达成共识.最终共有13个临床问题在本指南中必须形成推荐意见或说明(纳入),4个临床问题需根据证据质量与专家共识决定是否形成推荐意见(待定),形成14个关键结局,1个重要结局.结论:本研究通过三轮德尔菲法调查确定了需要纳入《心脏外科人血白蛋白合理使用快速建议指南》的临床问题与结局指标,为指南的后续制定工作奠定了良好的基础.

前不久,我院用药咨询门诊来了一名年轻的患者.他因上呼吸道感染来院就诊,医生询问病情后,给患者开了抗菌药物头孢克洛胶囊,让他回家后口服,并嘱咐患者服药期间及服药后至少1周内不要喝酒.患者因为听说过头孢类药物有许多服用禁忌,故又来用药咨询门诊询问药师,除酒精(乙醇)外,服用头孢类药物时还应注意什么?

目的探讨抗凝药物治疗管理门诊对华法林抗凝效果的影响.方法回顾性分析2019年7月至2020年1月于首都医科大学附属北京安贞医院抗凝药物治疗管理门诊拟服用或正在服用华法林的患者64例.记录患者一般情况、就诊目的、国际标准化比值(INR)、INR达稳时间、治疗范围内的时间百分比(TTR)、出血及血栓事件.结果患者平均年龄(60±12)岁,5例未戒烟、3例未戒酒,17例(26.6％)合并高血压,35例(54.7％)为机械瓣膜置换术后.患者共就诊143例次,109例次就诊目的为调整华法林剂量,此外,门诊药师监护患者异常情况29例次、更改其他抗凝药物12例次.可随访至华法林达稳的患者共17例,第5次就诊起INR水平逐渐趋于稳定,9例(52.9％)INR达稳时间<28 d,4例(23.5％)28 d≤INR达稳时间<42 d,2例(11.8％)42 d≤INR达稳时间<64 d,2例(11.8％)INR达稳时间≥64 d;2例(11.8％)TTR<40％、2例(11.8％)40％≤ TTR<60％、10例(58.8％)60％≤ TTR<80％、3例(17.6％)TTR≥80％,中位TTR为69.05％(63.05％,75.96％).用药期间发生小出血事件共有13例次,11例次发生在患者自行服用药物或于当地医院就诊期间,2例次发生在抗凝药物治疗管理门诊就诊期间.所有患者服药期间无血栓事件发生.结论以药师为主的抗凝治疗管理门诊可以为患者提供全面的、连续的治疗药物管理,提高患者依从性.