心脏瓣膜置换术后华法林疗效与维生素K环氧化物还原酶复合体亚单位1基因多态性的相关性研究

目的 探讨心脏瓣膜置换术后口服华法林的临床疗效及维生素K环氧化物还原酶复合体亚单位1(VKORC1)基因多态性对心脏瓣膜置换术后患者华法林维持剂量的影响.方法 选择行心脏瓣膜置换术的患者159例,术后口服华法林进行抗凝治疗,记录患者的凝血酶原时间(PT)、国际标准化比值(INR),统计安全的PT和INR范围;调整华法林维持剂量,采用PCR-PFLP技术对心脏瓣膜置换术患者进行VKORCI基因多态性检测,并进行比较.结果 心脏瓣膜置换术后口服华法林的PT安全监测范围为15.36～24.82 s,INR安全监测范围为1.33～2.62.抗凝过程中出血并发症的发生率为13.21％(21/159),VKORC1基因AA型华法林周剂量[(24.28±10.79) mg]显著高于GA型[(16.64±7.43) mg]和GG型[(12.12±7.17) mg],差异有统计学意义(P＜0.05或＜0.01).结论 VKORC1基因多态性是个体之间华法林维持剂量出现差异的主要因素,不同基因型患者间华法林用量存在一定的差异.心脏瓣膜置换术后口服华法林的临床PT及INR安全监测范围低于欧美国家的推荐范围,因此术后患者应定期进行指标的监测.     

如何调整华法林的用药剂量？

中国人应用华法林的初始剂量建议为3mg,目标INR依病情而定,一般为0．2-0．3mg;大于75岁的老年人和出血的高危患者,初始剂量应从2mg开始,每天一次口服,目标INR可以调低至1．6～2．5mg。如遇INR过高或过低,     

INRatio快速血凝分析仪检测国际标准化比值的临床应用价值

目的 比较INRatio快速血凝分析仪与标准实验室静脉血测定的国际标准化比值(INR)之间的相关性和一致性,判断INRatio快速血凝分析仪检测INR的临床应用价值.方法 选择100例口服华法林患者.同时抽取静脉血及指端末梢血,分别行标准SYSMEX CA-7000全自动凝血仪INR测定及INRatio快速血凝分析仪INR测定.比较两组结果的相关性、一致性.结果 当测量INR≤5时,INRatio快速血凝分析仪和SYSMEX CA-7000全自动凝血仪之间显示了良好的相关性(r=0.898,P=0.000);两种方法总体平均值偏倚差值为0.36,INRatio快速血凝分析仪比 SYSMEXCA-7000全自动凝血仪检测值高;通过Bland-Altman分析,两种方法INR平均值在1.60～3.50时,91.2％(62/68)的点在95％的一致性限度内,一致性良好;两种方法INR平均值＞3.50时,仅50.0％(1/2)的点在95％的一致性限度内,一致性差.结论 在治疗范围内,INRatio快速血凝分析仪检测的结果表现出与标准实验室结果良好的相关性和一致性,可以应用于临床对口服抗凝药患者INR的检测.     

纳豆引起服用华法林患者凝血改变1例

1临床资料患者,男性,81岁,因＂咳嗽、咳痰伴憋喘6年,加重并气短15d,发作性头晕、胸闷1个月余＂于2005年2月7日入院。患者经增强CT检查确诊为慢性肺动脉栓塞急性发作合并肺动脉高压、慢性阻塞性肺疾病,经抢救给予溶栓、抗凝血、降低肺动脉压力、改善微循环等治疗后,病情好转,头晕、气促等不适明显缓解。双肺螺旋CT提示双肺动脉广泛栓塞,     

华法林在心血管疾病中的应用与监测

华法林是一种双香豆素衍生物,通过干扰维生素K与2,3环氧化维生素K之间的转化循环而产生抗凝效应.华法林口服生物利用度好,起效和作用时间可以预测,在健康个体,口服90 min后浓度达到高峰,消旋体的华法林半衰期10～60 h[1].华法林在心血管疾病的应用广泛,但因易引起出血,而且要定期监测国际标准化比值INR,故临床上又大大限制了它的使用,现将华法林在心血管疾病的临床应用与监测方面综述如下.     

华法林抗凝目标国际标准化比值维持水平的长期随访研究

目的 利用国际标准化比值(INR)稳定度来评估在华法林抗凝目标值范围内的维持程度,从而找出INR与口服华法林患者血栓、出血发生率之间的联系.方法 分析2005年5月至2010年5月接受华法林抗凝治疗的129例非瓣膜性心房颤动患者的临床资料,计算所有患者的INR稳定度.INR稳定度定义为:同一时间段内在抗凝目标值范围内的INR检查数与INR检查总数的百分比.结果 随访时间中位数1.8年,随访期间内共获得有效INR检测结果为2574次(INR 0.9～6.0),其中在抗凝目标值范围(INR 2.0～3.0)之外的共有1085次(42.2％),INR稳定度为(60.9±14.9)％.发生卒中患者的INR稳定度明显高于非卒中患者[(61.2±15.0)％比(53.3±4.9)％,P＜ 0.05].对影响华法林抗凝强度的因素分析:其中不明原因573次(52.8％);服药依从性差214次(19.7％);食物结构的改变143次(13.2％);西药109次(10.0％);中药12次(1.1％);酒精饮料的摄入34次(3.1％).结论 华法林抗凝治疗期间,INR稳定度＞60％是安全有效的;在已知的影响华法林抗凝稳定性因素中服药依从性差仍然是主要因素.     

超高效液相色谱法测定血浆华法林浓度及临床应用

目的建立超高效液相色谱法(ultra performance liquid chromatography,UPLC)测定血浆华法林浓度,探讨心脏换瓣术后患者华法林血药浓度与国际标准化比率(international normalized ratio,INR)测值的关系,以寻求更安全可靠的监测指标,指导临床抗凝治疗的合理用药。 方法利用6-甲氧基萘乙酸作为内标,建立一种超高效液相色谱法,测定血浆中的华法林浓度。同时对79例样本的INR、华法林剂量和血浆华法林浓度进行相关性分析。 结果华法林和内标的保留时间分别是2.2和1.1 min,血浆中华法林的平均提取回收率为96.0%,华法林浓度在15.6~4000 ng/ml具有良好的线性(R²=0.9996),方法回收率为98.5%~99.9%,最低检测限为5.0 ng/ml。日内和日间精密度分别低于1.34%和2.69%。79例患者INR和华法林剂量相关性为r²=0.006(P=0.481),INR和血浆华法林浓度为r²=0.006(P=0.497),华法林剂量和血浆浓度相关性为r²=0.298(P=0.001)。 结论该方法是一种简便、快速、准确、灵敏的定量测定人体血浆中华法林浓度的UPLC方法,华法林血药浓度测定对于心脏瓣膜置换手术后患者的抗凝治疗具有指导意义。     

基层医院心房纤颤患者华法林应用现状

目的：探讨基层医院当中采用华法林抗凝治疗方法应用于心房纤颤患者临床当中的现状,并针对结果进行分析,为改善华法林抗凝治疗的临床应用提供借鉴。方法：选取2010年5月至2012年10月期间收治的258例心房纤颤患者临床资料进行回顾分析,对所有患者采用电话随访的方式收集后续资料与数据。结果：258例心房纤颤患者当中有88例应用了华法林进行抗凝治疗,其中长期进行监测同时国际标准化比值（INR）达标人数为42人,占9.3%。在应用华法林进行抗凝治疗的88例患者当中,54例为住院患者,34例为门诊患者。结论：在基层医院的华法林应用当中,抗凝的知晓率、应用率均较低,治疗率、监测率以及达标率同样偏低。因此在临床当中应当加强医患双方对于华法林抗凝治疗效果的认识,同时需要了解抗凝治疗的必要性与重要性,通过健康宣教以及正确的临床管理,改善监测方式与华法林的使用现状,进而减少由心房纤颤所致的致残率与致死率。     

你知道华法林如何用吗

华法林(Coumadin，Wafarin Sodium)是一种作用慢而持久的抗凝药，其特点是：     

服用华法林的饮食禁忌

76岁的吴先生患有高血压、糖尿病,甘油三酯稍高,平时自己在家监测血压和血糖,控制良好。一天,因自感心慌、胸闷到医院就诊,医生确诊为心房颤动．建议他使用华法林抗凝,并叮嘱他定期到医院抽血复查国际标准化比值（INR）。一天,吴先生突然出现血尿,到医院就诊,复查INR明显升高,为6．5,医生立即让他停服华法林,     

抗凝治疗的患者门诊INR监测结果分析

摘要:目的　了解服用华法林的患者门诊INR监测频率及INR达到理想范围的情况,为临床医生调整药物剂量及随访管理提供依据。方法　从邯郸市第一医院门诊化验系统导出2013年1月1日至12月31日所有服用华法林并进行INR（国际标准化测量值）检查的患者,数据信息包括:病例号、姓名、性别、年龄、所患疾病、INR测量值。结果　1年内,共获得INR监测记录931条。包括患者411例,平均年龄（57.3±13.7）岁,男性占46.2%,女性占53.8%。198例患者（48.2%）测量1次INR,仅17.3%的患者测量4次以上INR值,心脏瓣膜手术患者拥有4次以上测量结果的比例最高（27.3%）。以最后1次INR测量值作为标准,INR值在2.0～3.0范围的患者达到42.8%,213例测量2次以上INR的患者中,35.2%的患者每月测量1次INR值,其中44.6%的患者INR测量值中半数以上在达标范围（2.0～3.0）。931人次INR测量结果,INR在2.0～3.0者占38.7%。心脏瓣膜手术患者INR达标水平较高。结论　抗凝治疗的患者每月测量INR的比例低,门诊INR检查达标率达到40.0%,瓣膜手术患者INR达标率较高。     

Pharmacological adherence to oral anticoagulant and factors that influence the international normalized ratio stability

Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.     

Validity of criteria used to evaluate fingerstick devices that assess international normalized ratio.

BACKGROUND: Investigators commonly rely on unvalidated, mainly arithmetic criteria to predict if point-of-care fingerstick devices that assess International Normalized Ratio (INR) lead to the same warfarin dosing decisions as a standard measure. METHODS: Criteria that predict warfarin dosing agreement between 2 INR measurements were evaluated using clinicians' actual dosing decisions as the standard. Bayesian hierarchical modeling was used to rank the criteria by the proportion of correct dosing predictions and the magnitude of difference between actual and predicted dosing agreement. RESULTS: The prediction criteria misclassified dosing agreement for between 19% and 38% of paired INR values (x: 27%). The magnitude of misclassification varied inconsistently throughout the INR scale. CONCLUSION: The unvalidated criteria used to predict warfarin dosing agreement between 2 INR measurements are associated with large error. Warfarin dosing decisions should be measured directly in such assessments.     

Accuracy and clinical usefulness of the near-patient testing CoaguChek S international normalised ratio monitor in rural medical practice

OBJECTIVE: To compare the accuracy and clinical usefulness of the near-patient testing CoaguChek S INR monitor in rural medical practice. DESIGN, SETTING AND MAIN OUTCOME MEASURES: General practices were identified through Australian university departments of rural health. Study investigators trained general practitioners and/or practice nurses in the use of the CoaguChek S INR monitor. General practices obtained a fingerprick sample for testing with the INR monitor to compare with conventional pathology testing for accuracy. An evaluation questionnaire was administered to users of the machine to assess ease of use and clinical usefulness. RESULTS: A total of 169 patients from 15 general practice sites provided 401 paired (CoaguChek S and laboratory) INR results. The CoaguChek S was found to be accurate when compared to laboratory INR (r = 0.89), despite complicating variables such as multiple users of the monitor and multiple laboratories used for comparison with the CoaguChek S INR. Overall, 88% of dual INR measurements were within 0.5 INR units of each other. For laboratory INR /= 3.6, 97%, 90% and 57% of readings were within 0.5 INR units, respectively. Clinical agreement occurred 93% and 90% of the time against published expanded and narrow criteria, respectively. CONCLUSIONS: The routine use of near-patient testing, with appropriate training and quality assurance programs, has the potential to increase the safety and efficacy of warfarin therapy in rural and remote communities.     

Development of normalized curves for the international growth reference: historical and technical considerations

The World Health Organization recommended in 1978 that the National Center for Health Statistics/Centers for Disease Control growth reference curves be used as an international growth reference. To permit the expression of growth in terms of standard deviations, CDC developed growth curves from the observed data that approximate normal distributions. Because of significant skewness, standard deviations for weight-for-age and weight-for-height were calculated separately for distributions below and above the median. Standard deviations below the median were calculated from the 5th, 10th, 25th, and 50th observed percentiles while those above the median were based on the 50th, 75th, 90th, and 95th observed percentiles. Height-for-age distributions did not show significant skewness, thus, the standard deviations were calculated based on all six of the above observed percentiles. The normalized reference curves provide a highly useful data base that permits the standardized comparison of anthropometric data from different populations.     

2005年长沙国际机场蜚蠊监测报告

目的根据长沙国际机场2005年蜚蠊调查的情况,监测种群构成和蟑螂侵害的情况。方法按照国家质量监督检验检疫总局统一制定的方法进行监测。结果长沙国际机场的蟑螂优势种群由美洲大蠊变为德国小蠊,整个机场蟑螂侵害情况较严重且呈上升趋势,特别是航空配餐单位和航空器。结论及时指导机场相关部门采取生物、物理、化学等措施,综合防治,联合施药,集中杀灭,在短时间内将蟑螂密度降低至国家控制标准,保证国际机场卫生安全,常年达标。