Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Postgrad Med J. 2018 Apr;94(1110):207-211. doi: 10.1136/postgradmedj-2017-135457. Epub 2018 Feb 19.
The importance of time in therapeutic range (TTR) in patients prescribed warfarin therapy for stroke prevention in atrial fibrillation (AF) cannot be overemphasised.
To evaluate the impact of provision of TTR results during clinic visits on anticoagulation management.
Single-centred, randomised controlled study.
Fifteen arrhythmia clinics in Hong Kong.
AF patients prescribed warfarin.
Provision of TTR or no provision of TTR.
A documented discussion between doctors and patients about switching warfarin to a non-vitamin K oral anticoagulant (NOAC).
Four hundred and eighty one patients with AF prescribed warfarin were randomly assigned to (1) a TTR provision group or (2) control. Their mean age was 73.6±12.0 years and 60.7% were men. The mean CHADS-VASc score was 3.2±1.6 and the mean HASBLED score was 1.7±1.2. The mean TTR was 63.9%±29.9%. At the index clinic visit, 71 of 481 patients (14.8%) had a documented discussion about switching warfarin to a NOAC. Patients with provision of TTR results were more likely to discuss switching warfarin to a NOAC than controls (19.1% vs 10.6%, P=0.03), especially those with a TTR <65% (35.2% vs 10.6%, P<0.001). A higher proportion of patients with provision of TTR results switched to a NOAC (5.9% vs 4.1%, P=0.49).
The provision of TTR among patients on warfarin was associated with a discussion about switching from warfarin to a NOAC in those with TTR <65%, but did not result in actual switching to a NOAC, suggesting additional barriers.
在因心房颤动（AF）而接受华法林治疗以预防中风的患者中，治疗范围（TTR）时间的重要性怎么强调都不为过。
评估在就诊期间提供 TTR 结果对抗凝管理的影响。
单中心、随机对照研究。
香港的 15 个心律失常诊所。
服用华法林的 AF 患者。
提供 TTR 或不提供 TTR。
医生和患者之间记录在案的关于将华法林转换为非维生素 K 口服抗凝剂（NOAC）的讨论。
481 名服用华法林的 AF 患者被随机分配到（1）TTR 提供组或（2）对照组。他们的平均年龄为 73.6±12.0 岁，60.7%为男性。平均 CHADS-VASc 评分为 3.2±1.6，HASBLED 评分为 1.7±1.2。平均 TTR 为 63.9%±29.9%。在指数就诊时，481 名患者中有 71 名（14.8%）记录了关于将华法林转换为 NOAC 的讨论。与对照组相比，提供 TTR 结果的患者更有可能讨论将华法林转换为 NOAC（19.1%比 10.6%，P=0.03），尤其是 TTR<65%的患者（35.2%比 10.6%，P<0.001）。提供 TTR 结果的患者中有更高比例的患者转换为 NOAC（5.9%比 4.1%，P=0.49）。
在服用华法林的患者中提供 TTR 与 TTR<65%的患者中讨论从华法林转换为 NOAC 相关，但并未导致实际转换为 NOAC，表明存在其他障碍。
