Department of Medicine, General Internal Medicine, University Healthcare Thrombosis Service, University of Utah, Salt Lake City, Utah 84132, USA.
J Arthroplasty. 2010 Jan;25(1):121-7. doi: 10.1016/j.arth.2008.09.015. Epub 2008 Dec 5.
Venous thromboembolism (VTE) is a complication after joint arthroplasty, and pharmacologic prophylaxis is recommended to reduce this risk. Warfarin is often used, but initial dosing and management can be difficult. We studied a single-center prospective cohort of consecutive (n = 351) post-joint arthroplasty/revision patients who were initiated on warfarin using a new initiation nomogram and then discharged to home with home health services. The mean time to an international normalized ratio (INR) of 2.0 or higher was 5 days, with a mean INR of 2.1 on the fifth postoperative day. Two patients (0.6%) had an INR higher than 5 in the first 10 days of therapy. Adverse events were uncommon: 4 patients (1.14%) had VTE, 1 had major bleeding episode, and 6 patients (1.7%) had minor bleeding. A specific warfarin dosing nomogram managed by an anticoagulation service and used in joint arthroplasty/revision patients who are discharged to home with home health services leads to effective anticoagulation with few associated adverse events.
静脉血栓栓塞症（VTE）是关节置换术后的一种并发症，推荐使用药物预防来降低这种风险。华法林常被用于预防，但初始剂量和管理可能较为困难。我们研究了一个单中心连续（n=351）关节置换/翻修术后患者的前瞻性队列，他们使用新的起始剂量图开始使用华法林，然后在家中接受家庭健康服务出院。INR 达到 2.0 或更高的平均时间为 5 天，术后第 5 天的平均 INR 为 2.1。在治疗的前 10 天内，有 2 名患者（0.6%）的 INR 高于 5。不良事件并不常见：4 名患者（1.14%）发生 VTE，1 名患者发生大出血事件，6 名患者（1.7%）发生轻微出血。在接受家庭健康服务出院的关节置换/翻修患者中，由抗凝服务管理的特定华法林剂量图可有效抗凝，且相关不良事件较少。
