Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, CA 94143, USA.
Ann Emerg Med. 2011 Aug;58(2):192-9. doi: 10.1016/j.annemergmed.2011.01.018. Epub 2011 Apr 8.
To characterize warfarin management in the emergency department (ED).
This was a retrospective, cross-sectional, observational study of patients who were receiving warfarin and were discharged from a tertiary care, academic urban ED between June and August 2007. We abstracted patient demographics, presenting complaint, international normalized ratio (INR) if tested, indication for warfarin if documented, new medications administered or prescribed in the ED, and discharge instructions. Presenting complaints were categorized according to whether they were warfarin-related and concerning for thrombosis or bleeding. The primary outcome measure was the prevalence of warfarin therapy. The secondary outcome measures were frequency with which ED providers obtained an INR result, response to nontherapeutic results, administration or prescription of interacting medications, and percentage of patients receiving recommendations for anticoagulation follow-up.
Two percent (111/7,195) of all patients presenting to and discharged from the ED during the study period were found to be receiving warfarin. Seventy-one percent (79/111) had an INR checked. Nontherapeutic INRs were recorded for 49% (39/79) of patients; ED providers intervened to address these results in 21% (8/39) of cases. Seventy-one percent (5/7) of patients with a supratherapeutic INR received an intervention compared with 9% (3/32) of patients with a subtherapeutic INR. Seventeen percent (19/111) and 13% (14/111) of patients received or were prescribed potentially interacting medications, respectively. Recommendations for specific anticoagulation follow-up were documented for 19% (21/111) of all patients.
Patients receiving warfarin frequently present to the ED and often have nontherapeutic INRs. Potential areas for improvement in ED management include greater attention to subtherapeutic INRs, interacting medications, and discharge planning.
描述急诊科（ED）中使用华法林的情况。
这是一项回顾性、横断面、观察性研究，纳入了 2007 年 6 月至 8 月期间在一家三级医疗、学术型城市 ED 接受华法林治疗且出院的患者。我们提取了患者的人口统计学数据、就诊症状、如果检测了凝血酶原时间国际标准化比值（INR）则记录其数值、如果记录了华法林的使用指征则描述其指征、ED 期间给予或开具的新药物、以及出院指导。就诊症状根据是否与华法林相关、是否提示血栓或出血进行了分类。主要观察指标是华法林治疗的流行率。次要观察指标是 ED 提供者获取 INR 结果的频率、对非治疗性结果的反应、给予或开具相互作用药物的情况，以及接受抗凝随访建议的患者比例。
在研究期间，就诊并出院的 ED 患者中，有 2%（111/7195）正在接受华法林治疗。71%（79/111）的患者检测了 INR。49%（39/79）的非治疗性 INR 记录，21%（8/39）的情况下 ED 提供者干预了这些结果。71%（5/7）的 INR 高于治疗范围的患者接受了干预，而 INR 低于治疗范围的患者中只有 9%（3/32）接受了干预。17%（19/111）和 13%（14/111）的患者分别接受或开具了潜在相互作用的药物。19%（21/111）的所有患者均记录了具体的抗凝随访建议。
接受华法林治疗的患者经常到 ED 就诊，且往往 INR 结果不理想。ED 管理中有待改进的潜在领域包括更加关注 INR 低于治疗范围、相互作用的药物和出院计划。
