从最后一剂量开始的量化时间:直接口服抗凝剂试验是否与患者报告的最后一剂量相关
Brandon Stretton1,2,3, Joshua Kovoor1,2,3, Stephen Bacchi1,3,4
1Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide.
概括
患者回忆直接口服抗凝剂 (DOAC) 的最后剂量时间与DOAC测定标位有很强的相关性. 然而,老年人和体重不足的患者经常有意想不到的高DOAC水平,影响手术安全.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
- 患者安全 患者安全
背景情况:
- 直接口服抗凝剂 (DOAC) 的术前管理具有挑战性,因为最后一剂的时间是未知的.
- 建立可靠的方法来评估DOAC水平对于手术风险分层至关重要.
研究的目的:
- 为了评估患者报告的最后一次DOAC剂量时间和在现实手术队列中测量的DOAC测定标位之间的关联.
- 为了确定患有意外DOAC测定结果风险较高的患者子组.
主要方法:
- 一个多中心队列研究,涉及连续的外科住院患者.
- 根据报告的最后一剂量时间和既定指南,DOAC测定标位与预期水平进行了比较.
- 分析包括报告时间与标题的相关性,以及与意想不到的标题相关的因素的识别.
主要成果:
- DOAC测定标位与基于患者回忆的预期水平有很强的相关性 (rho = 0.70,P < 0.0001).
- 大约25%的患者表现出意想不到的DOAC测定标位.
- 体重不足 (<50公斤) 和老年人 (>80岁) 患者显著更有可能有意想不到的高DOAC标位.
结论:
- 患者对最后一次DOAC剂量的回忆是DOAC水平的合理可靠指标,但存在显著的差异.
- 意外高的DOAC水平发生在很大比例的患者身上,造成潜在的临床风险,特别是在脆弱人群中.
- 临床警和潜在的客观DOAC监测对于使用DOAC的老年和体重不足的外科患者是有必要的.
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