# 一名72歲心房顫動病患以apixaban出院。護理師應納入哪些病患安全衛教？請選擇所有適用的選項。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372753&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一名72歲心房顫動病患以apixaban出院。護理師應納入哪些病患安全衛教？請選擇所有適用的選項。

1

任何牙科處置、手術或侵入性處置前通知醫師，依規定停用apixaban。

2

除非醫囑，避免OTC NSAID（ibuprofen、naproxen）與含阿斯匹靈產品 — 增加出血風險。

3

使用軟毛牙刷、電動刮鬍刀並避免接觸性運動以減少輕傷出血。

4

居家防跌 — 走道淨空、照明充足、浴室扶手 — 並依需要使用輔具。

5

在家中備有口服維生素K，並在發生任何跌倒或頭部外傷後服用，以逆轉apixaban的抗凝血作用。

## 解析

Apixaban為第Xa因子抑制劑（DOAC）。所有抗凝血藥之病患安全衛教：(1)減少輕傷出血 — 軟毛牙刷、電動刮鬍刀、避免接觸性運動；(2)除非醫囑外避免OTC NSAID與阿斯匹靈 — NSAID增添血小板抑制與胃出血風險；(3)侵入性處置前依醫師指示停藥 — 通常24~48小時前；(4)防跌 — 服抗凝血劑的老人因輕微頭部外傷即有顱內出血高風險。選項5錯 — 維生素K為warfarin逆轉劑而非apixaban。Apixaban逆轉劑為andexanet alfa於醫院靜脈注射，非可攜帶之藥物。

## 深入解析

出血預防：軟毛牙刷、電動刮鬍刀、避免接觸性運動、除非醫囑禁用ASA/NSAID、處置前停藥。通報異常瘀青、黑色/柏油樣便、血尿、劇烈頭痛、暈眩或任何持續性出血。NSAID-抗凝血劑交互作用：NSAID於抗凝血效果上加上血小板抑制與胃黏膜損傷，倍增出血風險。服用抗凝血劑的病患偏好acetaminophen為OTC止痛藥。外用NSAID（diclofenac凝膠）全身效應較少但仍應由醫師核可。Apixaban逆轉：andexanet alfa（Xa因子抑制劑解毒劑）用於apixaban或rivaroxaban之致命性出血。維生素K僅逆轉warfarin。Idarucizumab為dabigatran之逆轉劑。逆轉劑於醫院給予，非病患攜帶。

## 臨床情境

**72歲心房顫動病患**以**apixaban**出院。護理師為新抗凝血劑提供安全衛教。

## 重要概念

- **出血預防** — 軟毛牙刷、電動刮鬍刀、避免接觸性運動、除非醫囑禁用ASA/NSAID、處置前停藥。通報異常瘀青、黑色/柏油樣便、血尿、劇烈頭痛、暈眩或任何持續性出血。
- **NSAID-抗凝血劑交互作用** — NSAID於抗凝血效果上加上血小板抑制與胃黏膜損傷，倍增出血風險。服用抗凝血劑的病患偏好acetaminophen為OTC止痛藥。外用NSAID（diclofenac凝膠）全身效應較少但仍應由醫師核可。
- **Apixaban逆轉** — Andexanet alfa（Xa因子抑制劑解毒劑）用於apixaban或rivaroxaban之致命性出血。維生素K僅逆轉warfarin。Idarucizumab為dabigatran之逆轉劑。逆轉劑於醫院給予，非病患攜帶。

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