患者对华法林治疗的自我管理 - 一项长期随访研究
Erland Hegardt Hall1,2, Marit Holm Sølsnes1, Sverre Sandberg3,4,5
1Department of Laboratory Medicine, Nordland Hospital in Bodø, Bodø, Norway.
Thrombosis journal
|February 10, 2025
概括
华法林治疗的患者自我管理 (PSM) 与传统的全科医生 (GP) 护理一样安全. 这种方法改善了治疗范围 (TTR) 的时间,并减少了适合患者的INR波动.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 患者对维生素K抗剂 (VKA) 治疗的自我管理 (PSM),特别是华法林,是维持治疗范围内的国际规范化比率 (INR) 的一种成熟方法.
- 临床实践中的质量保证项目,以比较PSM和传统的全科医生 (GP) 管理之间的长期华法林治疗安全性和有效性.
研究的目的:
- 评估患者自我管理 (PSM) 下的华法林治疗的长期有效性和安全性与传统的全科医生 (GP) 管理.
- 评估住院风险,治疗范围内的时间 (TTR),INR可变性和两组治疗中的极端INR值.
主要方法:
- 一项具有回顾性和前性设计的队列研究,涉及400名接受PSM培训的患者.
- 收集了因严重临床并发症而入院的数据,治疗范围内的时间 (TTR),INR波动和极端INR值.
- 主要结果:传统和PSM期间每年住院风险的差异.
主要成果:
- 严重出血 (1.25%PSM与1.69%常规) 或血栓形成 (0.67%PSM与1.48%常规) 的年度住院风险没有显著差异.
- 随着PSM,TTR中位数显著增加,从71.6%增加到78.6% (p < 0.001).
- 在PSM期间,INR变异降低 (21.0%至16.5%,p < 0.001),极端次治疗INR值降低 (14.0%至5.0%,p < 0.001).
结论:
- 长期评估表明,对于适当选择的患者,患者对华法林的自我管理 (PSM) 与传统的GP治疗一样安全.
- 在PSM中,抗凝血控制得到了改善,这可以通过增加TTR和减少INR变异性来证明.
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