门诊静脉血栓栓塞症患者抗凝手册的建立及有效性分析

目的评估门诊静脉血栓栓塞症(venous thromboembolism,VTE)患者抗凝手册的建立及其临床可行性、安全性和有效性。方法前瞻性分析上海交通大学医学院附属第九人民医院2018年10月至2019年3月采用门诊VTE抗凝手册的门诊VTE患者随访资料,主要研究终点为规范性抗凝的依从性,次要研究终点包括出血并发症发生率和症状性血栓复发率和失访率。结果门诊VTE患者规范性抗凝依从性为89.4%,其中口服利伐沙班和皮下注射低分子量肝素患者的依从性分别为92.9%和100%,口服华法林患者的依从性为77.8%。出血并发症发生率为5.3%,均为轻微出血。症状性血栓复发率为2.1%,均发生于口服华法林患者。患者总失访率为4.3%。结论建立门诊VTE患者抗凝手册可以有效提高患者治疗依从性,降低失访率,且具有较低的并发症发生率和血栓复发率。

Establishment and effectiveness analysis of anticoagulation manual for outpatients with venous thromboembolism

Objective To evaluate the establishment of anticoagulation manual for outpatients with venous thromboembolism(VTE) and its clinical feasibility, safety and effectiveness. Methods The followup data of VTE patients using the anticoagulation Manual of VTE in Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine from October 2018 to March 2019 were analyzed prospectively. The primary end point was the compliance with standard anticoagulation, and secondary end points included the incidence of bleeding complications, symptomatic thrombotic recurrence, and the rate of lost to follow-up. Results The standard anticoagulation compliance of outpatients with VTE was 89.4%.The compliance of patients with rivaroxaban and low molecular weight heparin were 92.9% and 100%,respectively. The compliance of patients with warfarin was 77.8%. The incidence of bleeding complications was 5.3%, and all of them were mild bleeding. The recurrence rate of symptomatic thrombosis was 2.1%,which occurred in patients treated with warfarin. The rate of lost to follow-up was 4.3%. Conclusion Establishment of a simple anticoagulation manual for outpatients with VTE can improve patients ’ therapy compliance and reduce the rate of lost to follow-up effectively, and is associated with a lower incidence of complications and thrombosis recurrence.