专人随访管理对心房颤动患者华法林抗凝达标的影响

目的研究专人随访管理对持续性心房颤动(房颤)患者服用华法林抗凝达标的影响。方法 随机选取160例持续性房颤患者,按就诊顺序编号分为随访管理组和对照组各80例,连续随访12个月。比较两组患者华法林服用剂量和华法林抗凝治疗的达标情况。结果(1) 管理组患者服用华法林平均剂量、INR首次达标后监测次数、INR全程监测频次明显少于对照组(P<0.05或0.01),两组间INR首次达标天数、INR达标所需监测次数、平均INR值比较差异无统计学意义(P>0.05)。(2) 两组患者华法林剂量调整频率存在显著差别(P<0.01),因INR过高、出血和新发血栓栓塞事件原因调整华法林剂量两组比较存在显著差别(P<0.05或0.01),因INR过低和和外出原因调整华法林剂量两组比较无显著差别(P>0.05)。(3) 连续随访12个月期间,在第1个月、第3个月、第4个月、第7个月、第9个月、第11个月和第12个月两组患者INR达标率存在显著差异(P<0.01)。(4) 两组患者出血事件的次数相比存在显著差异(P<0.05),其中轻度出血比较存在显著差异(P<0.05),中度和重度出血比较差异无统计学意义(P>0.05),两组患者血栓栓塞事件的次数比较差异无统计学意义(P>0.05)。结论 对持续性房颤患者服用华法林专人负责的随访管理可以减少患者华法林服用剂量和INR监测频次,提高华法林抗凝效果和达标率。

Personalized follow-up in management of anticoagulation therapy for patients with permanent atrial fibrillation

Objective To evaluate personalized follow-up in the management of warfarin anticoagulation therapy for patients with permanent atrial fibrillation. Methods One hundred and sixty patients with permanent atrial fibrillation receiving warfarin anticoagulation therapy were randomly divided into routine follow-up visit group(control group) and personalized follow-up management group(study group) with 80 cases in each group. All patients were subject to follow-up visit for 12 months. The international normalized ratio(INR) 1.8-3 was set as standard of anticoagulation; the warfarin dose and the meeting-standard rate were documented and compared between two groups. Results The average warfarin dose, the detection frequency after INR up to the standard for the first time and the detection frequency of INR during the whole course of study group were significantly lower than those of control group(P<0.05 or 0.01). There were no significant differences in the time and the detection frequency of up to the standard for the first time and the average INR value between two groups(P>0.05). The frequency of adjusting warfarin dose between the two groups was different significantly(P< 0.01); there were significant difference in reasons of adjusting warfarin dose including high INR, hemorrhage and new thromboembolism event between two groups(P<0.05 or 0.01), while there were no differences in reasons of low INR and leaving home between two groups(P>0.05). The rate of INR up to the standard in months 1,3, 4,7, 9,1 and 12 were significantly different between the two groups during the 12 months follow-up visit(P<0.01). The frequency of hemorrhage event between the two groups was different significantly(P< 0.05), among them, the frequency of hyporrhea was different significantly(P< 0.05), the moderate and severe hemorrhage were not different(P>0.05). The frequency of thromboembolism event between two groups was not different(P>0.05). Conclusion The personalized follow-up in management of warfarin anticoagulation therapy can decrease the warfarin dose and the detection frequency of INR; improve the anticoagulant effect and the up-to-standard rate for patients with permanent atrial fibrillation.