Zolfaghari Shabnam, Harenberg Job, Frölich Lutz, Weiss Christel, Wehling Martin, Wild Philip, Prochaska Jürgen, Beyer-Westendorf Jan, Koscielny Jürgen, Lip Gregory Y H
Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
Central Institute for Mental Health, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
Semin Thromb Hemost. 2015 Mar;41(2):166-77. doi: 10.1055/s-0035-1546467. Epub 2015 Feb 19.
Patients with indication for anticoagulation may prefer treatment with a vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC). A questionnaire may help to identify the preference of patients for one of the two types of oral anticoagulants and to develop a score for the recommendation to continue or to change the anticoagulant. A score was developed using a questionnaire containing biographic data and eight statements on attitudes on anticoagulation and was derived to trigger continuation or change the type of anticoagulant by defining ranges of terms and weighting of the significant statements identified by logistic regression analysis. Participating patients received either anticoagulation with VKA (group 1, n = 690), were transferred from VKA to NOAC (group 2, n = 158), received NOAC de novo (group 3, n = 137) or were transferred from NOAC to VKA (group 4, n = 19). Four statements were significantly (p values between 0.0347 and < 0.0001) associated with recommendations to maintain or to change the type of anticoagulant for patients in groups 1, 2, or 3 with predictive values of c = 0.83 between groups 1 and 2 and c = 0.71 between groups 1 and 3. From the total number of replies to the statements a score of three grades and two strengths (A = strong, B = moderate) was derived for the recommendations. This tool supports recommendations as to continue or to change the presently used type of oral anticoagulant based on the identification of patients' preferences.
有抗凝指征的患者可能更倾向于使用维生素K拮抗剂（VKA）或非维生素K拮抗剂口服抗凝药（NOAC）进行治疗。一份问卷可能有助于确定患者对这两种口服抗凝药中某一种的偏好，并制定一个评分系统，用于推荐继续使用或更换抗凝药。通过一份包含个人资料以及关于抗凝态度的八条陈述的问卷来制定评分系统，通过定义术语范围和对逻辑回归分析确定的重要陈述进行加权，得出该评分系统以触发继续使用或改变抗凝药类型。参与研究的患者要么接受VKA抗凝治疗（第1组，n = 690），从VKA转换为NOAC（第2组，n = 158），初治时接受NOAC（第3组，n = 137），要么从NOAC转换为VKA（第4组，n = 19）。对于第1、2或3组中患者维持或改变抗凝药类型的推荐，有四条陈述与之显著相关（p值在0.0347至<0.0001之间），第1组和第2组之间的预测值c = 0.83，第1组和第3组之间的预测值c = 0.71。根据对这些陈述的总回复数量，为推荐得出了一个有三个等级和两种强度（A = 强，B = 中等）的评分。该工具基于对患者偏好的识别，支持关于继续使用或改变当前所用口服抗凝药类型的推荐。
