Stigendal L, André U, Christenson B
Koagulationscentrum, Sahlgrenska Universitetssjukhuset, Göteborg.
Lakartidningen. 1999 May 19;96(20):2482, 2485-7.
As long-term anticoagulant treatment, with warfarin for instance, is associated with a risk of both thrombotic and thrombolytic complications, blood testing for dose regulation is necessary at 3-8-week intervals, which is expensive and inconvenient for patients who must take time off work and travel to and fro. A new technique, using small portable monitors designed for home use by patients, makes self-management of anticoagulant treatment possible. In Germany, over 25,000 patients had their own monitor by the end of 1998. After appropriate instruction, the German patients are able to monitor their prothrombin time and adjust their anticoagulant treatment accordingly. In case of problems they contact their GP. In a two-year pilot study conducted at the Anticoagulation Clinic of Sahlgrenska University Hospital, Gothenburg, in 1996-98, where 51 patients on long-term anticoagulant treatment were trained in self-management, the results of over 1,000 patient-hours of treatment showed self-management to be at least as safe as management by the clinic. The level of patient satisfaction is high, in terms of safety and freedom from regular hospital attendance during working hours, and the convenience of self-monitoring on holiday or business trips. As the patients do their testing once a week, the risk of complications is also reduced.
作为长期抗凝治疗，例如使用华法林，会伴有血栓形成和溶栓并发症的风险，因此需要每隔3至8周进行血液检测以调整剂量，这对于那些必须请假并来回奔波的患者来说既昂贵又不方便。一种新技术，即使用供患者在家中使用的小型便携式监测仪，使抗凝治疗的自我管理成为可能。在德国，到1998年底已有超过25000名患者拥有自己的监测仪。经过适当指导后，德国患者能够监测自己的凝血酶原时间并相应地调整抗凝治疗。遇到问题时，他们会联系自己的全科医生。1996年至1998年在哥德堡萨尔格伦斯卡大学医院抗凝门诊进行的一项为期两年的试点研究中，对51名接受长期抗凝治疗的患者进行了自我管理培训，超过1000个患者小时的治疗结果表明，自我管理至少与门诊管理一样安全。患者满意度很高，这体现在安全性、无需在工作时间定期去医院以及在度假或商务旅行时自我监测的便利性方面。由于患者每周进行一次检测，并发症的风险也降低了。
