抑郁和其他精神障碍对药师管理抗凝门诊抗凝控制的影响。

Effects of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic.

机构信息

Drake University College of Pharmacy & Health Sciences, Des Moines, IA, USA.

出版信息

Ann Pharmacother. 2013 Oct;47(10):1292-300. doi: 10.1177/1060028013503788.

DOI:10.1177/1060028013503788

PMID:24259693

Abstract

BACKGROUND

The impact of psychiatric disorders on International Normalized Ratio (INR) control and adverse events for patients receiving warfarin has not been fully elucidated.

OBJECTIVE

To determine the effect of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic.

METHODS

A retrospective chart review evaluated outcomes of patients with no history of psychiatric disorders and compare it with that of patients with either a history of depression or any form of psychiatric disorder. Data was obtained from patient medical records over a 24-month period. The primary outcome was a comparison of time in therapeutic range, calculated using 3 separate methods (percentage of INRs in therapeutic range, a modified Rosendaal's linear interpolation, and mean INR in goal).

RESULTS

A total of 151 patients met the inclusion criteria (control = 79, psychiatric disorders = 72 patients). Control patients had a significantly greater proportion of INRs in the goal range compared with either the depression or psychiatric disorders groups (control, 55.7%; depression, 43.5%; psychiatric, 45.8%). Utilizing the Rosendaal's method, patients with psychiatric disorders were in the goal range significantly less often than those in the control group (53.0% vs 61.3%). No differences were seen when adjusting for multiple comparisons or when comparing the control and depression groups (54.5% vs 61.3%). There was no difference between the groups when comparing percentages of patients with a mean INR in their goal range.

CONCLUSIONS

Patients with psychiatric disorders who take warfarin may spend less time in the therapeutic range.

摘要

背景

精神疾病对接受华法林治疗的患者的国际标准化比值（INR）控制和不良事件的影响尚未完全阐明。

目的

确定在药剂师管理的抗凝诊所中，抑郁和其他精神疾病对抗凝控制的影响。

方法

回顾性图表回顾评估了无精神疾病史患者的结局，并将其与有抑郁史或任何形式精神疾病史的患者进行比较。数据来自 24 个月的患者病历。主要结局是使用 3 种不同方法（治疗范围内的 INR 百分比、改良 Rosendaal 的线性插值和目标内平均 INR）比较治疗范围内的时间。

结果

共有 151 名患者符合纳入标准（对照组 79 例，精神疾病组 72 例）。与抑郁或精神疾病组相比，对照组患者的 INR 更接近目标范围的比例显著更高（对照组为 55.7%，抑郁组为 43.5%，精神疾病组为 45.8%）。使用 Rosendaal 方法，精神疾病组患者处于目标范围内的比例明显低于对照组（53.0%比 61.3%）。调整多重比较或比较对照组和抑郁组时，未见差异（54.5%比 61.3%）。比较平均 INR 在目标范围内的患者比例时，各组之间无差异。