【摘要】 目的：了解华法林在我院住院患者中的使用情况，分析其临床用药特点。方法：收集我院2020—2021年住院期间使用华法林的患者病历，并对患者的基本情况以及华法林使用的适应证、服用剂量、频次、国际标准化比值（INR）监测值、血浆凝血酶原时间、合并用药、药品不良反应等进行统计、分析。结果：我院使用华法林的临床适应证主要包括非瓣膜病心房颤动、肺栓塞、深静脉栓塞、动脉栓塞等，应用科室主要集中在内一科。患者年龄范围在42～97岁，华法林的剂量范围为0.63～3.75 mg/d，平均日剂量为1.96 mg，患者在住院期间INR波动范围在0.88～6.87。药品不良反应发生消化道出血的患者人数最多，占比57.14%，且出血情况随着联合用药种类的增多而加重，发生药品不良反应的人均联合用药种类为（4.85±2.06）种。结论：我院临床医师应用华法林还不够规范，抗凝专业临床药师应充分发挥自己的专业特点，积极开展服用华法林患者的药学监护及用药教育，确保安全、合理用药。更多还原

【Abstract】 Objective: To understand the use of warfarin in inpatients in our hospital, analyze its clinical medication characteristics. Methods: The medical records of patients who used warfarin in our hospital from 2020 to 2021 were collected, and the basic situation of patients and the indications, dosage, frequency, international normalized ratio(INR)monitoring value, plasma prothrombin time, combined medication, adverse drug reactions of warfarin were statistically analyzed. Results: The clinical indications of warfarin in our hospital mainly included nonvalvular atrial fibrillation,pulmonary embolism, deep vein embolism, arterial embolism, etc. The application departments were mainly concentrated in the first department of internal medicine. The age range of patients was 42-97 years old, the dose range of warfarin was 0.63-3.75 mg/d, and the average daily dose was 1.96 mg. The fluctuation range of INR during hospitalization was 0.88-6.87. The number of patients with gastrointestinal bleeding caused by adverse drug reactions was the largest, accounting for 57.14%, and the bleeding increased with the increase of the types of combined drugs. The per capita type of combined drugs for adverse drug reactions was(4.85±2.06). Conclusion: The application of warfarin by clinicians in our hospital is not standardized. Clinical pharmacists of anticoagulation specialty should give full play to their professional characteristics,actively carry out pharmaceutical care and medication education for patients taking warfarin, and ensure safe and rational drug use.更多还原