Introduction: Despite the rise of direct oral anticoagulants (DOACs), vitamin K antagonists (VKA) remain the most widely used oral anticoagulants in developing countries. The aim of this study was to estimate the prev...Introduction: Despite the rise of direct oral anticoagulants (DOACs), vitamin K antagonists (VKA) remain the most widely used oral anticoagulants in developing countries. The aim of this study was to estimate the prevalence of good anticoagulation in patients treated with VKA in Lomé and describe associated factors. Methods: This was a cross-sectional study conducted from November 2019 to October 2020 in the cardiology departments of two University teaching hospitals in Lomé (CHU Sylvanus Olympio and CHU Campus), involving patients on VKA for ≥3 months, with a target international normalized ratio (INR) of 2.5 and a therapeutic margin between 2 and 3. The quality of anticoagulation was assessed by the time in therapeutic range (TTR) which was assessed by the Rosendaal method. Good anticoagulation was defined by a TTR > 70%. Results: A total of 344 patients were included (mean age = 58 ± 13.8 years, women = 56.1%). Indications for VKA treatment were represented by venous thromboembolic disease (43.3%), supraventricular arrhythmia (28.2%), severe left ventricular systolic dysfunction (19.8%) and pulmonary hypertension (8.7%). The average TTR was 47.6 ± 20.8%. The rate of good anticoagulation was 17.7%. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol (OR = 11.17;95% CI: 3.2 - 39.6;p = 0.0002), concomitant low-dose aspirin (OR 4.44;95% CI: 1.4 - 13.9;p = 0.01) and INR monitoring exclusively by the patient himself (OR = 4.92;95% CI: 1.5 - 16.3;p = 0.008). The rate of thromboembolic and hemorrhagic complications was each 2.6% and was not correlated with the quality of anticoagulation. Quality of anticoagulation by VKAs was poor in our practice. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol, concomitant low-dose aspirin and monitoring of INR exclusively by the patient himself. Conclusion: The quality of oral anticoagulation by VKAs could be improved in our practice by the creation of anticoagulation clinics for better therapeutic e展开更多
目的:了解心房颤动(房颤)患者口服抗凝剂治疗过程中抗凝效果的疗效观察指标应用情况,比较不同疗效观察指标的优缺点及适用性。方法:运用Cochrane系统评价方法,检索MEDLINE,EMBASE和Cochrane Library近10年(1998年1月～2008年1月)关于口...目的:了解心房颤动(房颤)患者口服抗凝剂治疗过程中抗凝效果的疗效观察指标应用情况,比较不同疗效观察指标的优缺点及适用性。方法:运用Cochrane系统评价方法,检索MEDLINE,EMBASE和Cochrane Library近10年(1998年1月～2008年1月)关于口服抗凝剂(调整剂量华法林)疗效控制指标的文献进行系统评价。相关指标包括:在抗凝目标值范围内的时间百分比(percentage of time in therapeutic range,TTR),在抗凝目标值范围内的国际标准化比值(INR)百分比等。结果:根据纳入排除标准入选文献50篇,共计68个研究组。研究样本量从25例到6 454例不等(平均757例);研究或随访时间最短3个月,最长42个月(中位数12个月)。使用最多的抗凝控制指标为TTR[占研究总数69%(45/65)]和抗凝目标值范围内的INR百分比[占研究总数37%(24/65)]。仅有9%(6/65)的研究同时采用以上两种指标,两指标间差别有统计学意义[(59±13)%vs.(53±10)%,P=0.002],同时有显著直线相关关系(r=0.988,P<0.001)。结论:TTR和抗凝目标值范围内的INR百分比是目前最常用的抗凝控制指标。相关研究可以同时采用这两种指标,并结合其他指标使用,以弥补相互不足便于抗凝监控和比较。展开更多
目的:评估抗凝治疗范围内INR数目百分比(percentage of INR measurements in range, PINRR)评价房颤患者抗凝控制质量的临床价值。方法:对某院2017年6月-2019年6月服用华法林抗凝治疗的房颤患者进行为期1年的随访,计算PINRR和抗凝治疗...目的:评估抗凝治疗范围内INR数目百分比(percentage of INR measurements in range, PINRR)评价房颤患者抗凝控制质量的临床价值。方法:对某院2017年6月-2019年6月服用华法林抗凝治疗的房颤患者进行为期1年的随访,计算PINRR和抗凝治疗范围内INR时间百分比(time in therapeutic range, TTR),运用Pearson相关分析及ROC曲线分析评估PINRR评价抗凝控制质量的能力。随访期间记录患者脑卒中事件及出血事件,探讨PINRR与卒中发生率及出血发生率的相关性。结果:本研究共纳入209例患者,PINRR均值为(39.41±17.91)%,TTR均值为(42.46±19.18)%。PINRR与TTR呈线性相关,相关系数为0.843(P<0.001)。ROC曲线分析显示PINRR评价抗凝控制质量的最佳临界值是56.7%,提示PINRR≥56.7%的患者抗凝控制质量较好(TTR≥70%)。随访期间,32例患者(15.31%/年)发生缺血性脑卒中事件,6例患者(2.87%/年)发生出血事件。Kaplan-Meier生存分析显示,尽管PINRR≥56.7%的患者卒中和出血的年发生率均低于PINRR<56.7%的患者,但无显著性差异。结论:PINRR评分在评价抗凝控制质量方面表现良好,具有一定的临床应用价值。展开更多
文摘Introduction: Despite the rise of direct oral anticoagulants (DOACs), vitamin K antagonists (VKA) remain the most widely used oral anticoagulants in developing countries. The aim of this study was to estimate the prevalence of good anticoagulation in patients treated with VKA in Lomé and describe associated factors. Methods: This was a cross-sectional study conducted from November 2019 to October 2020 in the cardiology departments of two University teaching hospitals in Lomé (CHU Sylvanus Olympio and CHU Campus), involving patients on VKA for ≥3 months, with a target international normalized ratio (INR) of 2.5 and a therapeutic margin between 2 and 3. The quality of anticoagulation was assessed by the time in therapeutic range (TTR) which was assessed by the Rosendaal method. Good anticoagulation was defined by a TTR > 70%. Results: A total of 344 patients were included (mean age = 58 ± 13.8 years, women = 56.1%). Indications for VKA treatment were represented by venous thromboembolic disease (43.3%), supraventricular arrhythmia (28.2%), severe left ventricular systolic dysfunction (19.8%) and pulmonary hypertension (8.7%). The average TTR was 47.6 ± 20.8%. The rate of good anticoagulation was 17.7%. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol (OR = 11.17;95% CI: 3.2 - 39.6;p = 0.0002), concomitant low-dose aspirin (OR 4.44;95% CI: 1.4 - 13.9;p = 0.01) and INR monitoring exclusively by the patient himself (OR = 4.92;95% CI: 1.5 - 16.3;p = 0.008). The rate of thromboembolic and hemorrhagic complications was each 2.6% and was not correlated with the quality of anticoagulation. Quality of anticoagulation by VKAs was poor in our practice. Factors associated with good anticoagulation were the use of fluindione vs acenocoumarol, concomitant low-dose aspirin and monitoring of INR exclusively by the patient himself. Conclusion: The quality of oral anticoagulation by VKAs could be improved in our practice by the creation of anticoagulation clinics for better therapeutic e
文摘目的:了解心房颤动(房颤)患者口服抗凝剂治疗过程中抗凝效果的疗效观察指标应用情况,比较不同疗效观察指标的优缺点及适用性。方法:运用Cochrane系统评价方法,检索MEDLINE,EMBASE和Cochrane Library近10年(1998年1月～2008年1月)关于口服抗凝剂(调整剂量华法林)疗效控制指标的文献进行系统评价。相关指标包括:在抗凝目标值范围内的时间百分比(percentage of time in therapeutic range,TTR),在抗凝目标值范围内的国际标准化比值(INR)百分比等。结果:根据纳入排除标准入选文献50篇,共计68个研究组。研究样本量从25例到6 454例不等(平均757例);研究或随访时间最短3个月,最长42个月(中位数12个月)。使用最多的抗凝控制指标为TTR[占研究总数69%(45/65)]和抗凝目标值范围内的INR百分比[占研究总数37%(24/65)]。仅有9%(6/65)的研究同时采用以上两种指标,两指标间差别有统计学意义[(59±13)%vs.(53±10)%,P=0.002],同时有显著直线相关关系(r=0.988,P<0.001)。结论:TTR和抗凝目标值范围内的INR百分比是目前最常用的抗凝控制指标。相关研究可以同时采用这两种指标,并结合其他指标使用,以弥补相互不足便于抗凝监控和比较。
文摘目的:评估抗凝治疗范围内INR数目百分比(percentage of INR measurements in range, PINRR)评价房颤患者抗凝控制质量的临床价值。方法:对某院2017年6月-2019年6月服用华法林抗凝治疗的房颤患者进行为期1年的随访,计算PINRR和抗凝治疗范围内INR时间百分比(time in therapeutic range, TTR),运用Pearson相关分析及ROC曲线分析评估PINRR评价抗凝控制质量的能力。随访期间记录患者脑卒中事件及出血事件,探讨PINRR与卒中发生率及出血发生率的相关性。结果:本研究共纳入209例患者,PINRR均值为(39.41±17.91)%,TTR均值为(42.46±19.18)%。PINRR与TTR呈线性相关,相关系数为0.843(P<0.001)。ROC曲线分析显示PINRR评价抗凝控制质量的最佳临界值是56.7%,提示PINRR≥56.7%的患者抗凝控制质量较好(TTR≥70%)。随访期间,32例患者(15.31%/年)发生缺血性脑卒中事件,6例患者(2.87%/年)发生出血事件。Kaplan-Meier生存分析显示,尽管PINRR≥56.7%的患者卒中和出血的年发生率均低于PINRR<56.7%的患者,但无显著性差异。结论:PINRR评分在评价抗凝控制质量方面表现良好,具有一定的临床应用价值。
