Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, SE-118 83 Stockholm, Sweden.
Eur J Intern Med. 2012 Dec;23(8):742-4. doi: 10.1016/j.ejim.2012.07.011. Epub 2012 Aug 20.
Well-managed warfarin treatment with a high time in therapeutic range (TTR) corresponds to fewer bleedings or thromboembolic complications. Many small centres manage their warfarin dosing manually, with little or no knowledge of their treatment quality as measured by TTR. AuriculA is a Swedish National web-based anticoagulation dosing system. Our hypothesis was that the web based dosing system, compared to manual dosing, would improve the TTR.
Retrospective cohort study of medical records from patients with atrial fibrillation on warfarin treatment from two centres, with previously manual warfarin dosing regimens. Data for calculation of TTR was extracted manually from medical records from the time when using manual dosing and compared with the computerised regimen.
In centre 1, the mean TTR was significantly increased after the introduction of AuriculA, from 64.3% (95% CI 58.8-69.8) to 71.3% (95% CI 67.7-74.8), p=0.03. In centre 2, a high TTR of 73.6% (95% CI 71.3-75.9) was maintained after the implementation, 74.0% (95% CI 71.6-76.3). INR tests were prescribed significantly more frequent after the introduction of AuriculA in both centres; 20% more often at centre 1 and 21% at centre 2.
Computerised dosing assistance within the Swedish national quality registry AuriculA improves or maintains a high treatment quality with warfarin as measured by TTR.
华法林治疗管理良好，治疗时间在治疗范围内（TTR）对应更少的出血或血栓栓塞并发症。许多小型中心手动管理其华法林剂量，几乎不了解或根本不了解 TTR 测量的治疗质量。AuriculA 是瑞典国家基于网络的抗凝药物剂量系统。我们的假设是，与手动剂量相比，基于网络的剂量系统将改善 TTR。
这是一项来自两个中心的房颤患者服用华法林治疗的病历回顾性队列研究，此前使用的是手动华法林剂量方案。从使用手动剂量时的病历中手动提取 TTR 计算数据，并与计算机化方案进行比较。
在中心 1，引入 AuriculA 后 TTR 显著增加，从 64.3%（95%CI 58.8-69.8）增加到 71.3%（95%CI 67.7-74.8），p=0.03。在中心 2，实施后维持了 73.6%（95%CI 71.3-75.9）的高 TTR，74.0%（95%CI 71.6-76.3）。在引入 AuriculA 后，两个中心的 INR 测试都明显更频繁地开处方；中心 1 增加 20%，中心 2 增加 21%。
瑞典国家质量登记处 AuriculA 中的计算机化剂量辅助提高或维持了 TTR 测量的华法林治疗质量。
