Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, Louisiana 70121-2429, USA.
Adv Ther. 2010 Sep;27(9):623-33. doi: 10.1007/s12325-010-0056-z. Epub 2010 Jul 30.
Few studies have investigated current practices in the USA relating to warfarin use and monitoring, or the effects of warfarin discontinuation on risk of venous thromboembolism (VTE) and bleeding complications. This study investigated the effect of warfarin discontinuation on rates of VTE recurrence in a real-world setting.
Integrated Healthcare Information Services database records from January 2003 to September 2007 from patients aged at least 18 years, hospitalized for VTE, and with at least two prescriptions or 60 days of warfarin treatment were reviewed, with warfarin discontinuation and international normalized ratio (INR) data collated.
A total of 1027 of 8380 (12.3%) patients discontinued warfarin within 3 months. Overall, 1656 (19.8%) patients had no INR monitoring, with 38.1% of INR values being inside the therapeutic range (INR 2-3). Recurrent VTE was observed in 915 (10.9%) patients. Significant predictors of recurrent VTE (at any time) included discontinuation of warfarin within 3 months, time from index VTE to warfarin initiation, previous VTE-related hospitalization, and duration of index hospitalization.
This study found that in a real-world population, less than 50% of warfarin patients achieved INR values within the therapeutic range. Warfarin discontinuation within 3 months was associated with a higher rate of recurrent VTE.
很少有研究调查过美国目前在华法林使用和监测方面的实践，也很少有研究调查过华法林停药对静脉血栓栓塞（VTE）和出血并发症风险的影响。本研究调查了在真实环境中，华法林停药对 VTE 复发率的影响。
从 2003 年 1 月至 2007 年 9 月，对至少 18 岁、因 VTE 住院且至少有 2 份处方或 60 天华法林治疗的患者的综合医疗保健信息服务数据库记录进行了回顾，收集了华法林停药和国际标准化比值（INR）数据。
共有 8380 例患者中的 1027 例（12.3%）在 3 个月内停用华法林。总的来说，1656 例（19.8%）患者没有 INR 监测，其中 38.1%的 INR 值在治疗范围内（INR 2-3）。1656 例患者中有 1656 例（19.8%）患者没有 INR 监测，其中 38.1%的 INR 值在治疗范围内（INR 2-3）。共有 915 例（10.9%）患者出现 VTE 复发。VTE 复发的显著预测因素（任何时候）包括 3 个月内停用华法林、从 VTE 到开始使用华法林的时间、以前与 VTE 相关的住院治疗和指数住院时间。
本研究发现，在真实人群中，不到 50%的华法林患者 INR 值在治疗范围内。3 个月内停用华法林与更高的 VTE 复发率相关。
