用于预防中风的口服抗凝药的优化:对影响实施因素的范围审查
Jo Catherine Weldon1, Emma P Bray1, Josephine Gibson1
1Stroke Research Team, School of Nursing and Midwifery, University of Lancashire, Preston, UK.
BMJ open
|December 30, 2025
概括
有效的实施策略对于优化口服抗凝剂 (OAC) 治疗在中风预防方面至关重要. 本综述强调了常见和未充分利用的策略,以改善OAC的遵守和持久性.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
背景情况:
- 优化长期口服抗凝剂 (OAC) 治疗对于降低高风险人群中风风险至关重要.
- 需要有效的策略来支持药物开始,坚持和持续使用.
研究的目的:
- 对与实施旨在优化长期OAC遵守措施相关的基于证据的特征进行范围审查.
- 确定影响OAC管理干预措施成功实施的因素.
主要方法:
- 在五个数据库 (MEDLINE,Embase,CINAHL,PsycInfo,Cochrane Library) 进行了全面的搜索,搜索2000年以后发表的初级研究.
- 包括的研究评估了旨在通过改变服务,员工或患者行为来优化OAC实施的干预措施.
- 数据抽象和对实施内容的审查是根据实施变革 (ERIC) 战略的专家建议进行的.
主要成果:
- 包括216项研究,只有28%的研究被认为是实施研究.
- "培训和教育利益相关者"是最常见的策略,而"适应和适应环境"是最不常用的.
- 使用更多实施策略的研究是最近的,包括直接口服抗凝剂 (DOAC) 或维生素K对抗剂 (VKA),并针对多个干预水平 (服务,员工,患者).
结论:
- 需要研究将自己定义为实施研究,改善战略报告,并以透明的方式进行注册.
- 进一步的研究应该探索实施策略的差异化使用背后的原因及其对患者护理结果的影响.
- 对于未来的研究,建议对流程进行评估,并对实施流程进行更丰富的描述.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.0K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.0K
Venous Thrombosis III: Interprofessional Care
257
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
257
Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.6K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.6K
Venous Thrombosis IV: Nursing Management
176
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
176
Atherosclerosis III: Management
291
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
291
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
1.0K
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
1.0K


