对华法林在治疗深静脉血栓形成和/或肺栓塞中的控制情况的重新评估。

A re-appraisal of warfarin control in the treatment of deep vein thrombosis and / or pulmonary embolism.

作者信息

Amiwero C, Campbell I A, Prescott R J

机构信息

Federal Medical Centre, Department of Haematology and Blood Transfusion, Bida, Niger state, Nigeria.

出版信息

Afr Health Sci. 2009 Sep;9(3):179-85.

PMID:20589148

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2887034/

Abstract

BACKGROUND

Warfarin is commonly used for management of deep vein thrombosis (DVT) and pulmonary embolism (PE), controlling therapy by means of the International Normalized Ratio (INR).

OBJECTIVES

To identify differences in INR results between patients with thromboembolic and haemorrhagic complications and controls.

METHODS

Two nested case-control studies from within a controlled trial of the duration of warfarin therapy (47 thrombotic and 16 haemorrhagic complications).

RESULTS

Patients whose thromboembolism failed to resolve during treatment or recurred during or after treatment had non-significantly lower INR levels than matched controls (geometric mean 2.2 versus 2.3, p = 0.12). Patients with haemorrhage also had not statistically significant lower INR levels than their matched controls (2.1 versus 2.3, p = 0.22). The variability of INR levels was similar in both case groups and controls. The mean percentage of INR levels in the therapeutic range 2 - 3 was almost identical in thrombotic cases and controls (56.5% versus 56.1%). Compared to the haemorrhagic group, better control was achieved in controls (61.5% versus 43.0%, p=0.01), but controls had slightly more INR values above the therapeutic range (12.1% versus 10.5%, p = 0.74) whilst haemorrhagic cases had more INR values below the therapeutic range (46.6% versus 26.4%, p = 0.03).

CONCLUSION

In this study, higher INR levels were not associated with haemorrhage suggesting that, for patients being treated for DVT/PE, a modest increase in the target therapeutic range could be considered.

摘要

背景

华法林常用于治疗深静脉血栓形成（DVT）和肺栓塞（PE），通过国际标准化比值（INR）来控制治疗。

目的

确定血栓栓塞和出血并发症患者与对照组之间INR结果的差异。

方法

在一项关于华法林治疗持续时间的对照试验中进行两项嵌套病例对照研究（47例血栓形成和16例出血并发症）。

结果

在治疗期间血栓栓塞未缓解或在治疗期间或之后复发的患者，其INR水平略低于匹配的对照组（几何平均值分别为2.2和2.3，p = 0.12），差异无统计学意义。出血患者的INR水平也略低于其匹配的对照组（2.1和2.3，p = 0.22），差异无统计学意义。两个病例组和对照组中INR水平的变异性相似。血栓形成病例和对照组中INR水平在治疗范围2 - 3内的平均百分比几乎相同（56.5%对56.1%）。与出血组相比对照组的控制更好（61.5%对43.0%，p = 0.01），但对照组INR值高于治疗范围的略多（12.1%对10.5%，p = 0.74），而出血病例INR值低于治疗范围的更多（46.6%对26.4%，p = 0.03）。