维生素K拮抗剂相关脑出血逆转电子医嘱集的前后对照研究。

Before-After Study of an Electronic Order Set for Reversal of Vitamin K Antagonist-Associated Intracerebral Hemorrhage.

作者信息

Vitt Jeffrey R, Do Lynn V, Shah Nirav H, Fong Gary, Nguyen Nicole Y, Kim Anthony S

机构信息

Department of Neurology, University of California San Francisco, San Francisco, CA, USA.

Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA.

出版信息

Neurohospitalist. 2018 Jan;8(1):18-23. doi: 10.1177/1941874417714706. Epub 2017 Jun 22.

DOI:10.1177/1941874417714706

PMID:29276558

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5734508/

Abstract

BACKGROUND

Vitamin K antagonist (VKA)-associated intracerebral hemorrhages (ICHs) are more likely to expand and are associated with higher mortality than primary ICH. Prompt reversal of anticoagulant effect with prothrombin complex concentrate (PCC) may promote hemostasis and decrease hematoma expansion. The aim of this study was to evaluate the impact of an electronic order set designed to standardize and facilitate more timely reversal of coagulopathy in VKA-associated ICH.

METHODS

We identified all adults who received PCC for VKA-associated ICH from June 2012 to June 2015 at University of California San Francisco Medical Center, which included a period before and after an electronic order set became available in 2014. We abstracted baseline demographics and clinical data from electronic health records. The primary outcome was time from radiographic identification of ICH to administration of PCC.

RESULTS

Thirty-one patients received PCC for VKA-associated ICH, including 17 patients before and 14 patients after the order set became available. Baseline demographics and clinical features were similar. Order set use was associated with a significant decrease in the time from identification of ICH on imaging to the administration of PCC (median 83 vs 45 minutes; = .02), more accurate dosing (29.4% vs 92.9%; < .01), and a shorter time from the PCC order to follow-up international normalized ratio (INR) testing (median 164 vs 85 minutes, = .001).

CONCLUSION

An electronic order set for administering PCC for VKA-associated ICH was associated with significantly faster time to PCC administration and increased dosing accuracy.

摘要

背景

与维生素K拮抗剂（VKA）相关的脑出血（ICH）比原发性ICH更易扩大，且死亡率更高。使用凝血酶原复合物浓缩剂（PCC）迅速逆转抗凝作用可能促进止血并减少血肿扩大。本研究的目的是评估一种电子医嘱集的影响，该医嘱集旨在规范并促进更及时地逆转VKA相关ICH中的凝血病。

方法

我们确定了2012年6月至2015年6月在加利福尼亚大学旧金山医学中心因VKA相关ICH接受PCC治疗的所有成年人，这包括2014年电子医嘱集可用之前和之后的时间段。我们从电子健康记录中提取了基线人口统计学和临床数据。主要结局是从影像学识别ICH到给予PCC的时间。

结果

31例患者因VKA相关ICH接受了PCC治疗，其中17例在医嘱集可用之前，14例在医嘱集可用之后。基线人口统计学和临床特征相似。使用医嘱集与从影像学识别ICH到给予PCC的时间显著缩短（中位数83分钟对45分钟；P = 0.02）、给药更准确（29.4%对92.9%；P < 0.01）以及从PCC医嘱到后续国际标准化比值（INR）检测的时间缩短（中位数164分钟对85分钟，P = 0.001）相关。