华法林抗凝治疗质量评价及影响因素分析

目的：对华法林抗凝治疗质量的评价和影响因素进行分析，为进一步加强对华法林的管理而提供数据支持。方法：收集符合纳入标准的85例服用华法林患者的相关临床资料，计算每位患者抗凝治疗范围内时间百分比the percentage time in therapeutic International Norrnalised Ratio （INR） range，TTR]评价抗凝控制质量，并对可能影响TTR的因素进行分析。结果：85例患者的TTR为（50.45±28.52）%，抗凝质量较好（TTR ≥ 60%）的患者仅占40%。对可能影响TTR的因素进行单因素回归分析，结果显示年龄、是否同服抗血小板药物、住院期间是否有抗凝临床药师驻科，差异具有显著性（P<0.05）；其他因素如是否进行华法林基因检测，是否合并高血压、糖尿病、肝/肾功能不全、脑梗塞、外周血管疾病，是否合用胺碘酮、中药汤剂等，差异无显著性。结论：本研究显示年龄、是否同服抗血小板药物、住院期间是否有抗凝临床药师驻科是影响华法林抗凝控制质量的相关因素，鉴于本研究60%的患者抗凝质量不佳，需要进一步加强华法林的抗凝管理。

Quality evaluation and analysis of influencing factors on the anticoagulant therapy of warfarin

OBJECTIVE To analyze the quality evaluation and influencing factors of warfarin anticoagulant therapy, and to provide data support for further intensifying the management of warfarin.METHODS The clinical data of 85 patients who received warfarin were collected and the quality of anticoagulation control was evaluated by calculating the percentage of time in therapeutic international norrnalized ratio (INR) (TTR). The factors that might influence TTR were analyzed.RESULTS The TTR of 85 patients were (50.45±28.52)%. Patients with good anticoagulant quality (TTR>60%) only accounted for 40%. Univariate regression analysis of the factors that may affect TTR showed that there was a statistically significant difference (P<0.05) in age, combination with antiplatelet drugs, and existance of an anticoagulant clinical pharmacist in the department during hospitalization; there was no significant difference in other factors such as whether warfarin gene testing was performed, whether hypertension, diabetes, liver/renal insufficiency, cerebral infarction, peripheral vascular disease, and whether amiodarone and Chinese herbal decoction were used together.CONCLUSION This study shows age,combination with antiplatelet drugs and existance of professional clinical pharmacists of anticoagulants in the department during hospitalization are the relevant factors affecting the quality of anticoagulation control of warfarin. Considering the poor quality of anticoagulant in 60% of the patients in this study, the anticoagulant management of warfarin should be further strengthened.