Egermayer P, Inder A, Town G I
Department of Medicine, Christchurch School of Medicine, University of Otago.
N Z Med J. 2001 Jul 27;114(1136):336-8.
To identify the actual duration of warfarin therapy received by patients being treated for venous thromboembolism (VTE) compared to that initially intended. To determine the incidence of major haemorrhage during therapy.
The subjects were 505 consecutive medical inpatients who were referred for a lung scan because of suspected pulmonary embolism. Three years following the discharge of the last patient, hospital notes, local and national computer databases were searched for subsequent relevant events. Surviving subjects were also contacted by telephone or letter.
115/505 (23%) received warfarin therapy for VTE. Direct personal contact was made with 314/352 (89%) surviving patients, including 79/82 (98%) surviving patients who were on warfarin. The intended duration of therapy was specified initially in 60/115 treated cases (52%), and these patients were less likely to be still receiving warfarin 3-4 years later (p<0.001). Indefinite therapy was initially recommended in 11/115 cases (10%), but 26/79 surviving subjects (32%) were known to be still receiving warfarin 3-4 years later. Seven treated subjects had a diagnosed recurrence of VTE. There were no clear indications for prolonged therapy in the remainder. Major haemorrhage occurred eighteen times among 115 treated patients (16%), and in two of these warfarin associated bleeding was considered to be the cause of death. None of these events was reported to the Centre for Adverse Reactions Monitoring.
The intended duration of therapy was often unclear and warfarin was generally continued for much longer than is currently considered necessary. Haemorrhagic events were relatively common and were not reported.
确定接受华法林治疗的静脉血栓栓塞症（VTE）患者实际接受治疗的时长，并与最初计划的时长进行比较。确定治疗期间大出血的发生率。
研究对象为505例因疑似肺栓塞而接受肺部扫描的连续住院内科患者。在最后一名患者出院三年后，检索医院病历、本地及国家计算机数据库以查找后续相关事件。还通过电话或信件联系了在世的研究对象。
115/505（23%）的患者因VTE接受了华法林治疗。与314/352（89%）名在世患者进行了直接个人联系，其中包括79/82（98%）名正在接受华法林治疗的在世患者。在115例接受治疗的病例中，最初明确了治疗计划时长的有60例（52%），这些患者在3 - 4年后仍接受华法林治疗的可能性较小（p<0.001）。最初建议11/115例（10%）患者接受 indefinite therapy（此处原文有误，应为长期治疗），但在3 - 4年后，已知有26/79名在世患者（32%）仍在接受华法林治疗。7例接受治疗的患者被诊断为VTE复发。其余患者无延长治疗的明确指征。115例接受治疗的患者中有18例发生大出血（16%），其中2例华法林相关出血被认为是死亡原因。这些事件均未上报至不良反应监测中心。
治疗计划时长通常不明确，华法林的持续使用时间普遍比目前认为必要的时间长得多。出血事件相对常见且未上报。
