Phillips Katherine W, Ansell Jack
Boston University School of Medicine, Department of Medicine, Boston, MA 02118, USA.
Expert Rev Cardiovasc Ther. 2008 Jan;6(1):57-70. doi: 10.1586/14779072.6.1.57.
Oral anticoagulation therapy with warfarin is the mainstay of prevention and treatment of thromboembolic disease. However, it remains one of the leading causes of harmful medication errors and medication-related adverse events. The beneficial outcomes of oral anticoagulation therapy are directly dependent upon the quality of dose and anticoagulation management, but the literature is not robust with regards to what constitutes such management. This review focuses on, and attempts to define, the parameters of high-quality anticoagulation management and identifies the appropriate outcome measures constituting high-quality management. Elements discussed include the most fundamental measure, time in therapeutic range, along with other parameters including therapy initiation, time to therapeutic range, dosing management when patients are not in therapeutic range, perioperative dosing management, patient education, and other important outcome measures. Healthcare providers who manage oral anticoagulation therapy should utilize these parameters as a measure of their performance in an effort to achieve high-quality anticoagulation management.
使用华法林进行口服抗凝治疗是预防和治疗血栓栓塞性疾病的主要手段。然而，它仍然是有害用药错误和药物相关不良事件的主要原因之一。口服抗凝治疗的有益结果直接取决于剂量质量和抗凝管理，但关于这种管理的构成，文献并不充分。本综述重点关注并试图界定高质量抗凝管理的参数，并确定构成高质量管理的适当结果指标。讨论的要素包括最基本的指标——治疗范围内的时间，以及其他参数，包括治疗开始、达到治疗范围的时间、患者不在治疗范围内时的剂量管理、围手术期剂量管理、患者教育以及其他重要的结果指标。管理口服抗凝治疗的医疗服务提供者应利用这些参数来衡量其表现，以努力实现高质量的抗凝管理。
