Britt R P, James A H, Raskino C L, Thompson S G
Department of Haematology, Hillingdon Hospital, Uxbridge, Middlesex.
J Clin Pathol. 1992 Nov;45(11):1003-6. doi: 10.1136/jcp.45.11.1003.
To determine what factors influence the precision of anticoagulant control using warfarin by examining the computerised records of 2207 patients.
Records from seven district general hospitals were combined and analysed. The precision of anticoagulant control was taken as the absolute deviation of International Normalised Ratio (INR) from target at the most recent determination. This quantity was examined using univariate and multiple regression analyses.
Deviation of INR from target was continuously distributed, almost symmetrically about a mean of zero. The patients' age and sex had little bearing on control. Patients with a high target INR were more likely to be undertreated, and patients taking higher doses of warfarin were more likely to be overtreated. Previous over- or undertreatment were strongly related to poorer current control. The control of treatment varied substantially among the seven hospitals. One possible cause of this variation was the dose adjustment coefficient: the greater the dose adjustment for a given deviation from target INR, the better was the control achieved.
Several groups of patients were identified whose control was less satisfactory and in whom anticoagulant treatment needs particular scrutiny: these include patients with a record of previous over- or undertreatment, but not elderly patients in general. The variation in control among hospitals is a source of concern that merits further attention to achieve better uniformity of anticoagulant treatment.
通过检查2207例患者的计算机记录，确定哪些因素会影响使用华法林进行抗凝控制的精准度。
合并并分析了七家地区综合医院的记录。抗凝控制的精准度以最近一次测定时国际标准化比值（INR）与目标值的绝对偏差来衡量。使用单变量和多元回归分析对该指标进行了研究。
INR与目标值的偏差呈连续分布，以均值零为中心近似对称。患者的年龄和性别对控制效果影响不大。目标INR较高的患者治疗不足的可能性更大，服用较高剂量华法林的患者治疗过度的可能性更大。既往的治疗过度或不足与当前较差的控制效果密切相关。七家医院之间的治疗控制情况差异很大。造成这种差异的一个可能原因是剂量调整系数：对于与目标INR的给定偏差，剂量调整越大，实现的控制效果越好。
确定了几组控制效果不太理想且抗凝治疗需要特别仔细检查的患者：这些患者包括既往有治疗过度或不足记录的患者，但一般不包括老年患者。医院之间控制情况的差异令人担忧，值得进一步关注以实现抗凝治疗更好的一致性。
