Department of Clinical Biochemistry, Vejle Hospital, Vejle, Denmark.
Telemed J E Health. 2011 Apr;17(3):169-76. doi: 10.1089/tmj.2010.0128. Epub 2011 Jan 23.
We have developed an expert computer system for the control of oral anticoagulation therapy, accessible by the patients via their own computer. To investigate if the weekly measurement and dosing of international normalized ratio (INR) at home using the online Internet-based system was superior to conventional treatment, we performed a randomized, controlled trial.
All 669 patients in our anticoagulation clinic were asked to participate in the trial, providing that they had Internet access and could use the CoaguChek XS system. A total of 140 patients were included and randomized to (A) once weekly measurement and report online, (B) twice weekly measurement and report online, and (C) continued conventional treatment with INR measurement in the lab every 4 weeks and dose adjustment by letter.
Group A had 79.7% (95% CI 79.0-80.3) of time in therapeutic range (TTR), group B 80.2% (95% CI 79.4-80.9) of TTR, and group C 72.7% (95% CI 71.9-73.4) TTR. Groups A and B perform statistically significantly better than the conventional group C, with a difference of TTR of 7% points (p < 2.2 × 10(-16)), whereas no difference was seen between A and B.
Home measurement of INR and the reporting and dosing of results online once a week increase TTR from 72% to 79% as compared to conventional computer-assisted monitoring in an anticoagulation clinic.
我们开发了一个专家计算机系统，用于控制口服抗凝治疗，患者可通过自己的计算机使用该系统。为了研究在家中使用基于互联网的在线系统每周测量和调整国际标准化比值（INR）是否优于传统治疗，我们进行了一项随机对照试验。
我们要求所有在我们抗凝门诊的 669 名患者参与试验，条件是他们有互联网接入并能够使用 CoaguChek XS 系统。共有 140 名患者入组并随机分为（A）每周一次在线测量和报告，（B）每周两次在线测量和报告，以及（C）继续传统治疗，每 4 周在实验室测量 INR 并通过信函调整剂量。
A 组的治疗时间百分比（TTR）为 79.7%（95%置信区间 79.0-80.3），B 组为 80.2%（95%置信区间 79.4-80.9），C 组为 72.7%（95%置信区间 71.9-73.4）。A 组和 B 组的 TTR 明显优于传统组 C 组，TTR 差异为 7%（p<2.2×10(-16)），而 A 组和 B 组之间无差异。
与抗凝门诊中的传统计算机辅助监测相比，在家中测量 INR 并每周在线报告和调整剂量可将 TTR 从 72%提高到 79%。
