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目的:探讨定期随访对出院患者华法林抗凝治疗效果和安全性的影响。方法:研究对象为2009年1月至2010年1月在解放军总医院心血管中心住院期间应用华法林抗凝治疗未达到稳定剂量、出院3个月内仍需持续服用该药的患者。按随机数字表法将患者分为随访组和对照组。随访调查采用电话访问,对随访组患者每周访问1次,对照组患者仅在出院后3个月时访问1次。主要了解患者华法林剂量调整、国际标准化比值(INR)监测、合并用药、饮食情况以及出血或血栓等不良反应发生情况;另外,根据随访结果敦促患者定期测定INR和调节华法林剂量。结果:总共200例患者纳入本研究并分为2组,每组100例患者。随访组男62例,女38例,平均年龄(57.0±16.2)岁;对照组男47例,女53例,平均年龄(59.6±13.4)岁。出院后3个月内,随访组坚持服用华法林并达到稳定剂量者比例高于对照组(75%比53%,P=0.00);随访组失访和非医源性停药者比例低于对照组(11%比22%,6%比15%,均P=0.04);随访组未监测INR者比例与对照组相近(8%比10%,P=0.62)。随访组患者出院至达稳定剂量所需时间短于对照组[(38.7±19.0)d比(54.5±45.6)d,P=0.03];随访组INR>3但<4和INR≥4者比例[分别为14.7%(11/75)和10.7%(8/75)]均少于对照组[分别为30.2%(16/53)和24.6%(13/53)],差异有统计学意义(均P=0.04);随访组发生出血事件者比例低于对照组[4.0%(3/75)比11.3%(6/53)],但差异无统计学意义(P=0.21)。随访期间,2组患者均未出现血栓性事件。结论:定期随访可提高出院患者华法林抗凝治疗依从性和疗效,并可能有助于减少出血等不良反应的发生。
Objective: To investigate the effect of regular follow-up on the efficacy and safety of warfarin anticoagulation in discharged patients. Methods: The study was conducted from January 2009 to January 2010 in the People’s Liberation Army General Hospital Cardiovascular Center during the application of warfarin anticoagulation did not reach a stable dose, still discharged within 3 months of the patient still need to take the drug. The patients were divided into follow-up group and control group according to random number table method. Follow-up survey using telephone interview, visit patients in the follow-up group once a week, patients in the control group were interviewed only once 3 months after discharge. Mainly to understand the patient warfarin dose adjustment, the international standardization ratio (INR) monitoring, combination therapy, diet and bleeding or thrombosis and other adverse reactions; In addition, based on the follow-up results to urge patients to regularly measure INR and regulate warfarin dose. RESULTS: A total of 200 patients were included in this study and divided into two groups of 100 patients each. The follow-up group included 62 males and 38 females, with an average age of 57.0 ± 16.2 years. There were 47 males and 53 females with a mean age of (59.6 ± 13.4) years. Within 3 months after discharge, follow-up group insisted on taking warfarin and reached a stable dose, the proportion was higher than the control group (75% vs 53%, P = 0.00); Follow-up group lost and non-medical withdrawal rate was low (11% vs 22%, 6% vs 15%, both P = 0.04). The proportion of untreated INR in the follow-up group was similar to that in the control group (8% vs 10%, P = 0.62). Patients in the follow-up group had shorter discharge time to stable dose than those in the control group [(38.7 ± 19.0) d vs (54.5 ± 45.6) d, P = 0.03] (14.7% (11/75) and 10.7% (8/75)] in the control group were significantly lower than those in the control group [30.2% (16/53) and 24.6% (13/53, respectively]] P = 0.04). The proportion of bleeding in the follow-up group was lower than that in the control group [4.0% (3/75) vs 11.3% (6/53)], but the difference was not statistically significant (P = 0.21). During follow-up, no thrombotic events occurred in either group. CONCLUSIONS: Regular follow-up improves the adherence and efficacy of warfarin anticoagulation in discharged patients and may help to reduce adverse reactions such as bleeding.