Nichol Michael B, Knight Tara K, Dow Tom, Wygant Gail, Borok Gerald, Hauch Ole, O'Connor Richard
Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, Los Angeles, CA 90033, USA.
Ann Pharmacother. 2008 Jan;42(1):62-70. doi: 10.1345/aph.1K157. Epub 2007 Dec 19.
Prior research suggests that receiving specialized anticoagulation services enables patients to achieve better clinical outcomes.
To assess the quality of anticoagulation therapy in patients with atrial fibrillation who were enrolled in an anticoagulation clinic (ACC) versus usual care (UC).
Using Sharp Rees-Stealy physician group claims data, we estimated time spent in therapeutic range and time to first major bleeding episode or stroke for ACC and UC patients. t-Tests were used to compare time in therapeutic range proportions, and Kaplan-Meier survival analysis was performed to compare rates of bleeding and stroke between groups.
We identified 1107 patients (351 ACC, 756 UC) treated with anticoagulation therapy for atrial fibrillation with more than one international normalized ratio (INR) reported between March 2001 and March 2004. ACC patients spent a greater proportion (68.14%) of time in therapeutic range compared with UC patients (42.07%; p < 0.001). There was a significant difference between groups in average time between INR tests (ACC = 14.31 days, UC = 18.39 days; p < 0.001). ACC patients were 59% less likely to experience a bleed following the index date than were UC patients (HR = 0.41; 95% CI 0.2444 to 0.6999; p = 0.001), but type of care was not a significant predictor for stroke (HR = 0.95; 95% CI 0.5125 to 1.7777; p value NS).
Results from this observational study reinforce the positive impact that anticoagulation services have on anticoagulation therapy outcomes, emphasizing the importance of providing such services for patients undergoing treatment with warfarin.
先前的研究表明，接受专业的抗凝服务能使患者获得更好的临床结果。
评估纳入抗凝门诊（ACC）的心房颤动患者与接受常规护理（UC）的患者的抗凝治疗质量。
利用夏普·里斯 - 斯蒂利医生集团的索赔数据，我们估算了ACC和UC患者处于治疗范围内的时间以及首次发生重大出血事件或中风的时间。采用t检验比较处于治疗范围内的时间比例，并进行卡普兰 - 迈耶生存分析以比较两组之间的出血和中风发生率。
我们确定了1107例接受心房颤动抗凝治疗的患者（351例ACC，756例UC），在2001年3月至2004年3月期间报告了不止一个国际标准化比值（INR）。与UC患者（42.07%；p < 0.001）相比，ACC患者处于治疗范围内的时间比例更高（68.14%）。两组之间INR检测的平均时间存在显著差异（ACC = 14.31天，UC = 18.39天；p < 0.001）。与UC患者相比，ACC患者在索引日期后发生出血的可能性低59%（风险比 = 0.41；95%置信区间0.2444至0.6999；p = 0.001），但护理类型不是中风的显著预测因素（风险比 = 0.95；95%置信区间0.5125至1.7777；p值无统计学意义）。
这项观察性研究的结果强化了抗凝服务对抗凝治疗结果的积极影响，强调了为接受华法林治疗的患者提供此类服务的重要性。
