Veterans Affairs Center for Medication Safety, Hines, Illinois, USA.
J Am Geriatr Soc. 2010 Aug;58(8):1475-80. doi: 10.1111/j.1532-5415.2010.02967.x. Epub 2010 Jul 19.
To describe the quality of warfarin prescribing and monitoring in Veterans Affairs (VA) nursing homes and to assess the factors associated with maintaining a therapeutic international normalized ratio (INR).
Retrospective cohort.
Five VA nursing homes.
All veterans who received warfarin between January 1 and June 30, 2008, at the nursing homes.
Using medical records, the percentage of person-time spent in the target INR range, the proportion of patients with INRs in the therapeutic range on 50% or more of their person-days, and the frequency of INR monitoring were estimated. Multivariable logistic regression was used to identify factors associated with maintaining a therapeutic INR 50% or more of the time.
Over 6 months, 160 patients received 10,380 person-days of warfarin. INRs were in the therapeutic range for 55% of the person-days, and 99% of the INR tests were repeated within 4 weeks of the previous result. On an individual level, 49% of patients had INRs in the target range for 50% or more of their person-days. Achieving this outcome was more likely in patients with prevalent warfarin use than with new use (adjusted odds ratio (AOR)=2.86, 95% confidence interval (CI)=1.06-7.72). Conversely, patients with a history of a stroke (AOR=0.38, 95% CI =0.18-0.80) were less likely to have therapeutic INRs for 50% or more of their days.
Warfarin appears to be prescribed and monitored effectively in VA nursing home patients. Future studies should focus on increasing time in therapeutic range in patients with poor INR control.
描述退伍军人事务部（VA）疗养院中华法林的开具和监测质量，并评估与维持治疗性国际标准化比值（INR）相关的因素。
回顾性队列研究。
VA 疗养院内的 5 家疗养院。
疗养院内于 2008 年 1 月 1 日至 6 月 30 日期间接受华法林治疗的所有退伍军人。
使用病历记录，估计目标 INR 范围内的个人时间百分比、INR 在治疗范围内的患者比例（占其个人天数的 50%或以上）以及 INR 监测的频率。采用多变量逻辑回归分析确定与维持治疗性 INR 50%或以上时间相关的因素。
在 6 个月期间，有 160 名患者接受了 10380 人天的华法林治疗。INR 处于治疗范围内的时间占个人天数的 55%，并且 99%的 INR 检测是在上一次结果的 4 周内重复进行的。在个人层面上，49%的患者 INR 在治疗范围内的时间占其个人天数的 50%或以上。与新使用者相比，有华法林既往使用史的患者更有可能达到这一结果（调整后的优势比（AOR）=2.86，95%置信区间（CI）=1.06-7.72）。相反，有中风史的患者（AOR=0.38，95%CI=0.18-0.80）INR 达到治疗范围的时间比例更低。
VA 疗养院的华法林使用和监测似乎是有效的。未来的研究应重点提高 INR 控制不佳的患者的治疗范围时间。
