乙氨基和其他危险因素对过度的华法林抗凝剂的危险因素
E M Hylek1, H Heiman, S J Skates
1Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
JAMA
|March 13, 1998
概括
乙氨基的使用是过度华法林抗凝剂 (升高的INR) 的重要,未被认可的原因. 其他危险因素包括新的药物,恶性瘤,疾病和错误的华法林剂量,需要增加INR监测.
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:
- 华法林对于预防血栓栓塞至关重要,但具有显著的出血风险,特别是在国际正常化比率 (INR) 超过4.0的情况下.
- 识别过度抗凝的原因对于管理患者安全和预防临床实践中的不良事件至关重要.
- 高INR (大于4.0) 需要谨慎管理,以减轻与华法林治疗相关的出血风险.
研究的目的:
- 调查和确定国际正常化比率 (INR) 在门诊环境中超过6.0的主要原因.
- 确定在接受华法林治疗的患者中导致过度抗凝的特定危险因素.
- 通过突出危险高的INR值的可预防原因,为临床实践提供信息.
主要方法:
- 在门诊抗凝剂治疗单位进行了一项病例对照研究.
- 对接受华法林治疗超过一个月,目标INR为2.0-3.0的患者进行了前性跟踪.
- 在24小时内采访了病例 (INR > 6.0) 和对照组 (INR 1.7-3.3),以评估药物使用,饮食,疾病和酒精消费等因素.
主要成果:
- 摄入乙氨基显示了与INR大于6.0的剂量依赖关联,在高剂量 (≥9100毫克/周) 中,风险增加了10倍.
- 独立相关的因素包括新增增强药物 (OR 8.5),晚期恶性瘤 (OR 16.4),腹疾病 (OR 3.5),口服摄入量减少 (OR 3.6),以及服用华法林超过处方 (OR 8.1).
- 较高的维生素K摄入量 (OR 0.7) 和习惯的适度饮酒 (OR 0.2) 与过度抗凝血的风险降低有关.
结论:
- 乙氨基是对华法林治疗的门诊患者过度抗凝的未被认可的贡献者.
- 确定了其他几种重要的临床风险因素,包括药物相互作用和患者相关因素.
- 建议加强INR监测和风险因素修改,以减少危险高的抗凝血水平的发生率.
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