华法林治疗起始阶段国际标准化比值及维持剂量的预测
Prediction of the international normalized ratio and maintenance dose during the initiation of warfarin therapy.
作者信息
Vadher B, Patterson D L, Leaning M
机构信息
Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, N19 5NF, UK.
出版信息
Br J Clin Pharmacol. 1999 Jul;48(1):63-70. doi: 10.1046/j.1365-2125.1999.00967.x.
AIMS
A pharmacokinetic/pharmacodynamic model, with Bayesian parameter estimation, was used to retrospectively predict the daily International Normalized Ratios (INRs) and the maintenance doses during the initiation of warfarin therapy in 74 inpatients.
METHODS
INRs and maintenance doses predicted by the model were compared with the actual INRs and the eventual maintenance dose. Cases with drugs or medical conditions interacting with warfarin or receiving concurrent heparin therapy were not excluded. As the study was retrospective, model predictions of the maintenance dose were not those that were administered. Mean prediction error (MPE) and percentage absolute prediction errors (PAPE) were used to assess the model predictions.
RESULTS
INR MPE ranged from -0.07 to 0.06 and median PAPE from 10% to 20%. Dose MPE ranged from -0.7 to 0.17 mg and median PAPE from 16.7% to 37.5%. Accurate and precise dose predictions were obtained after 3 or more INR feedback's.
CONCLUSIONS
This study shows that the model can accurately predict daily INRs and the maintenance dose in this sample of cases. The model can be incorporated into computer decision-support systems for warfarin therapy and may lead to improvement in the initiation of warfarin therapy.
目的
采用具有贝叶斯参数估计的药代动力学/药效学模型，回顾性预测74例住院患者华法林治疗起始阶段的每日国际标准化比值（INR）和维持剂量。
方法
将模型预测的INR和维持剂量与实际INR及最终维持剂量进行比较。未排除使用与华法林相互作用的药物或患有相关疾病或接受肝素联合治疗的病例。由于本研究为回顾性研究，维持剂量的模型预测并非实际给予的剂量。采用平均预测误差（MPE）和绝对预测误差百分比（PAPE）评估模型预测。
结果
INR的MPE范围为-0.07至0.06，PAPE中位数为10%至20%。剂量的MPE范围为-0.7至0.17mg，PAPE中位数为16.7%至37.5%。经过3次或更多次INR反馈后，获得了准确且精确的剂量预测。
结论
本研究表明，该模型能够准确预测本样本病例中的每日INR和维持剂量。该模型可纳入华法林治疗的计算机决策支持系统，可能会改善华法林治疗的起始阶段。
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