在一个由药剂师管理的抗凝诊所网络中，非治疗性华法林抗凝的流行病因学。

Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.

J Clin Pharm Ther. 2011 Feb;36(1):64-70. doi: 10.1111/j.1365-2710.2009.01155.x.

WHAT IS KNOWN AND OBJECTIVE

There is wide inter-patient and intra-patient variability in the pharmacodynamic profile of warfarin. To determine the prevailing aetiologies of non-therapeutic warfarin anticoagulation episodes among patients currently enrolled in an outpatient anticoagulation clinic and compare the relative frequency in which they occur compared to therapeutic anticoagulation regimens.

METHODS

Prospective, observational cohort study set within three pharmacist-managed anticoagulation clinics in a community outpatient health system. Patients were included, if they were seen for an office visit during the 6-month period from September 2006 to March 2007 and evaluated for the presence or absence of 12 investigational factors linked to non-therapeutic anticoagulation results. Multivariate stepwise logistic regression performed to assess predictive value of each factor.

RESULTS

A total of 5817 patient-visits were documented producing 2886 (49.6%) non-therapeutic and 2931 (50.4%) therapeutic International Normalized Ratio (INR) readings. The most prevalent aetiologies linked to non-therapeutic INR results included change in dietary vitamin K intake (16.9%, OR 6.4), non-compliance (15.0%, OR 4.9), and initiation of anticoagulant therapy (9.9%, OR 2.3). The factor with the highest predictive value of non-therapeutic INR results was a change in health status (OR 9.5) despite its lower rate of frequency (4.9%). Despite identification of many causative factors in this study, 40.2% of non-therapeutic INR readings had no known aetiology. In the end, the lack of any study factor was a greater predictor of therapeutic anticoagulation (86.2%), than the presence of a study factor was for predicting non-therapeutic INR values (51.4%).

WHAT IS NEW AND CONCLUSION

Change in health status was the strongest predictor of non-therapeutic INR levels out of the investigational factors evaluated. Our study demonstrated that there are many aetiologies for non-therapeutic INR values that were not explained by our investigational factors.

已知和目的

华法林的药效学特征在患者之间和患者内部存在广泛的变异性。本研究旨在确定当前在门诊抗凝门诊就诊的患者中非治疗性华法林抗凝治疗发作的主要病因，并比较它们与治疗性抗凝方案相比发生的相对频率。

方法

这是一项在社区门诊医疗系统中由 3 家药剂师管理的抗凝诊所进行的前瞻性观察队列研究。纳入标准为：在 2006 年 9 月至 2007 年 3 月的 6 个月期间就诊的患者，并评估 12 种与非治疗性抗凝结果相关的研究因素是否存在。采用多元逐步逻辑回归分析评估每个因素的预测价值。

结果

共记录了 5817 次患者就诊，其中 2886 次（49.6%）为非治疗性国际标准化比值（INR）读数，2931 次（50.4%）为治疗性 INR 读数。与非治疗性 INR 结果相关的最常见病因包括饮食维生素 K 摄入的变化（16.9%，OR 6.4）、不依从（15.0%，OR 4.9）和抗凝治疗的开始（9.9%，OR 2.3）。尽管非治疗性 INR 结果的病因频率较低（4.9%），但健康状况的改变是其最具预测价值的因素（OR 9.5）。尽管在本研究中发现了许多病因，但仍有 40.2%的非治疗性 INR 读数无已知病因。最终，与研究因素相比，没有任何研究因素是预测治疗性抗凝的更强因素（86.2%）。