Tosetto Alberto, Manotti Cesare, Marongiu Francesco
Department of Hematology, S. Bortolo Hospital, Vicenza, Italy.
Hemostasis Center, Fidenza-Vaio Hospital, Fidenza, Italy.
PLoS One. 2015 Dec 4;10(12):e0144314. doi: 10.1371/journal.pone.0144314. eCollection 2015.
Center-specific TTR (c-TTR) is a measure reporting the mean patient TTR within an anticoagulation clinic describing the quality of anticoagulant monitoring offered by that clinic. c-TTR has a considerable between-center variation, but its determinants are poorly understood.
We aimed at evaluating which clinical, procedural or laboratory factors could be associated with c-TTR variability in a multicenter, observational cross-sectional study over a five-year period.
PATIENTS/METHODS: Data from 832,204 individual patients followed for VKA therapy in 292 Centers affiliated with the Italian Federation of Anticoagulation Clinics (FCSA) were analyzed. c-TTR was computed based on the TTR of patients followed at each Center, and a mixed linear regression model was used for a predefined set of explanatory variables.
The Center next-visit interval ratio (the mean number of days after a visit with an INR outside the therapeutic range, divided by the days after a visit with an INR within the therapeutic range), the Center mean patient INR and the Center laboratory performance at EQA proficiency testing were the only variables that were independently associated with c-TTR (β-coefficients -17.32, 9.67, and -0.11, respectively; r2 = 0.635).
These findings suggest that c-TTR associates with proactive strategies aimed at keeping patients very close to their target INR with a prompt re-evaluation of those patients with under- or over-therapeutic INR.
特定中心的凝血酶原时间比值（c-TTR）是一种衡量指标，用于报告抗凝门诊内患者凝血酶原时间比值的平均值，描述该门诊提供的抗凝监测质量。c-TTR在不同中心之间存在相当大的差异，但其决定因素尚不清楚。
我们旨在评估在一项为期五年的多中心观察性横断面研究中，哪些临床、程序或实验室因素可能与c-TTR变异性相关。
患者/方法：分析了意大利抗凝门诊联合会（FCSA）下属292个中心的832204例接受维生素K拮抗剂（VKA）治疗患者的个体数据。c-TTR基于每个中心随访患者的凝血酶原时间比值计算得出，并使用混合线性回归模型对一组预先定义的解释变量进行分析。
中心下次就诊间隔比（国际标准化比值（INR）超出治疗范围后就诊的平均天数除以INR在治疗范围内后就诊的天数）、中心患者平均INR以及中心在室间质量评价能力验证中的实验室表现是仅有的与c-TTR独立相关的变量（β系数分别为-17.32、9.67和-0.11；r2 = 0.635）。
这些发现表明，c-TTR与旨在使患者非常接近其目标INR并及时重新评估INR低于或高于治疗范围患者的积极策略相关。
