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|本期目录/Table of Contents|

心房颤动患者口服抗凝剂疗效指标选择的系统评价

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第2期
页码:
186-189
栏目:
临床研究
出版日期:
2010-03-04

文章信息/Info

Title:
Optimal measures of oral anticoagulation in atrial fibrillation: a systematic review
作者:
万毅1; 陈万2; 3; 李妮3; 杜晓晗1; 张玉海1; 徐勇勇1
1.第四军医大学预防医学系卫生统计学教研室,陕西 西安 710032；2.重庆医科大学 附属第一医院心内科，重庆 400016；3.重庆市九龙坡区第一人民医院，重庆 400050
Author(s):
WAN Yi1;  CHEN Wan2; 3;  LI Ni3;  DU Xiao-han1;  ZHANG Yu-hai1;  XU Yong-yong1
1.Department of Health Statistics, Fourth Military Medical University, Xi’an 710032, Shaanxi, China; 2.Department of Cardiovascular, Affiliated First Hospital, Chongqing Medical University, Chongqing 400016, China; 3.First People’s Hospital, Jiulongpo Dis
关键词:
抗凝剂; 系统评价; 心房颤动; 维生素K拮抗剂; 国际标准化比值; 目标值范围内时间
Keywords:
anticoagulation;  systematic review;  atrial fibrillation;  vitamin K antagonist;  international normalized ratio;  time in therapeutic range
分类号:
R541.71；R973.2
DOI:
-
文献标识码:
A
摘要:
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。
Abstract:
AIM: To evaluate different measures of oral anticoagulation in patients with atrial fibrillation (AF) and to compare the application of different measures in clinical practice. METHODS: Evidence-based method was used to search MEDLINE, EMBASE and Cochrane Library (1998 to 2008) for studies (with adjusted dosage warfarin therapy) reporting international normalized ratio (INR) control measures as percentage of time in range (TTR), percentage of INRs in range, and percentage of patients in range and other same measures. RESULTS: Fifty publications with 68 study groups were identified. The sample size of studies was from 25 to 6 454 (mean 757). Duration or follow-up of studies was from 3-42 months (median: 12 months). TTR (69%) and percentage of INRs in range (37%) were the most popular measures. Only 9% of the total studies used both measures at the same time. A significant difference was found between the two measures ［(59±13)% vs.(53±10)%, P=0.002］, and a significant correlation was also found (r=0.988, P<0.001). CONCLUSION: TTR and percentage of INRs in range are the most popular measures used in anticoagulation control.

参考文献/References

［1］ Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in Collaboration With the North American Society of Pacing and Electrophysiology［J］. J Am Coll Cardiol, 2001, 38(4):1231-1266.

［2］ Ansell J, Hirsh J, Poller L, et al. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy［J］. Chest, 2004, 126(3 Suppl):204S-233S.

［3］ Hylek EM, Skates SJ, Sheehan MA, et al. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation［J］. N Engl J Med, 1996, 335(8):540-546.

［4］ Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial［J］. Lancet, 1996, 348(9028):633-638.

［5］ Ansell JE. Anticoagulation Management as a Risk Factor for Adverse Events: Grounds for Improvement［J］. J Thromb Thrombolysis, 1998, 1(3):13-18.

［6］ Taylor F, Ebrahim S. Consensus needed for evaluating safe and adequate anticoagulant control［J］. Arch Intern Med, 2001, 161(12):1558.

［7］ Cannegieter SC, Rosendaal FR, Wintzen AR, et al. Optimal oral anticoagulant therapy in patients with mechanical heart valves［J］. N Engl J Med, 1995, 333(1):11-17.

［8］ Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management［J］. J Thromb Thrombolysis, 2000, 9(3):283-292.

［9］ Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?［J］. Control Clin Trials, 1996, 17(1):1-12.

［10］Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials［J］. BMJ, 1999, 319(7211):670-674.

［11］Schmitt L, Speckman J, Ansell J. Quality assessment of anticoagulation dose management: comparative evaluation of measures of time-in-therapeutic range［J］. J Thromb Thrombolysis, 2003, 15(3):213-216.

［12］Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagulant therapy［J］. Thromb Haemost, 1993, 69(3):236-239.

备注/Memo

备注/Memo:
收稿日期：2009-5-17.基金项目：国家自然科学基金课题资助（90612012） 通讯作者：徐勇勇，教授，主要从事卫生管理与卫生信息研究Email:xuyongy@fmmu.edu.cn 作者简介：万毅，博士Email:wanyi@fmmu.edu.cn
更新日期/Last Update: 2010-03-05