在接受华法林治疗的患者中,治疗时间范围随着目标国际正常化比率范围的增加而下降
Imran Malik1, Paul Priest2, Ian Jennings3
1University College London.
概括
为华法林患者扩大目标国际正常化比率 (INR) 范围可能会减少治疗时间范围 (TTR). 较高的INR值也表明INR测定性能降低,影响治疗疗效.
科学领域:
- 临床化学 临床化学
- 药理学 药理学是指药理学的学科.
- 医疗质量保证 医疗质量保证
背景情况:
- 华法林治疗需要对国际正常化比率 (INR) 进行仔细监测,以确保疗效并尽量减少出血风险.
- 治疗时间范围 (TTR) 是评估抗凝管理质量的关键指标.
- 目前的指导方针建议大多数接受华法林治疗的患者的标准INR范围为2.0至3.0.
研究的目的:
- 调查改变目标INR范围是否会影响战化患者的TTR.
- 为了确定INR测定性能是否随着绝对INR值的增加而恶化.
主要方法:
- 分析了22项英国国家外部质量保证计划 (NEQAS) 对INR绩效指标的调查.
- 在6,584个华法林监测情节中对TTR的评估,按INR范围和指示分层.
- 无共识百分比和平均报告的INR值之间的统计相关性.
主要成果:
- 样本INR> 3.0的NEQAS调查显示,参与者在共识之外增加,变化系数更高,平均值的标准误差更大.
- 在没有共识的参与者百分比和平均报告的INR值之间观察到负相关性.
- 当他们的目标INR范围设置在标准2.0至3.0以上时,华法尼化患者表现出较低的TTR.
结论:
- 在较高的INR值下,INR试验的性能下降.
- 扩大目标INR范围超过2.0-3.0对战患者的TTR产生不利影响.
- 试图通过增加INR范围来提高华法林疗效的尝试可能会悖论地降低治疗的有效性.
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