Schapkaitz Elise, Louw Susan, Friedman Jessica, Sithole Johanna, Masebe Mavis, Jacobson Barry F
1 Department of Molecular Medicine and Haematology, Charlotte Maxeke Johannesburg Academic Hospital National Health Laboratory System Complex, University of Witwatersrand, Johannesburg, South Africa.
2 Department of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, South Africa.
Clin Appl Thromb Hemost. 2018 Nov;24(8):1255-1260. doi: 10.1177/1076029618783250. Epub 2018 Jun 21.
Despite long-standing experience with warfarin, anticoagulation clinic services are often confronted with the challenging clinical situation of patients with overanticoagulation. This requires repeat international normalized ratio (INR) monitoring and in some cases administration of vitamin K to minimize the risk of bleeding. A study was performed to determine the safety and efficacy of outpatient management in order to provide guidance on the management of patients with prolonged INRs. Patients on stable warfarin therapy for more than 1 month attending a dedicated academic hospital anticoagulation clinic who had an INR ≥5 were identified over a 1-year period. Follow-up INR results and outcomes were recorded for 30 days. One hundred and ninety-five episodes of overanticoagulation in 148 patients were identified. Patients were classified as low risk (n = 85, 57.4%) and moderate risk of bleeding (n = 63, 42.6%). The mean index INR was 7.22 (1.88). Management with low-dose oral vitamin K (n = 32, 16.4%) did not significantly result in a more rapid correction of the INR when compared to conservative management (n = 163, 83.6%; P = .103). Follow-up INR testing was performed at a mean of 11.1 (8.9) days from the index measurement. A mean of 1.6 (0.9) follow-up INR tests were performed per episode. During the 30-day follow-up, there was 1 (0.5%) episode of major bleeding and 1 (0.5%) death. The management of asymptomatic outpatients with overanticoagulation is associated with a low risk of major bleeding within 30 days. Conservative management of overanticoagulation is as effective as utilizing low-dose oral vitamin K.
尽管华法林的使用已有长期经验，但抗凝门诊服务常常面临患者抗凝过度这一具有挑战性的临床情况。这需要反复监测国际标准化比值（INR），在某些情况下还需给予维生素K，以将出血风险降至最低。开展了一项研究以确定门诊管理的安全性和有效性，从而为INR延长患者的管理提供指导。在1年期间，识别出在一家专门的学术医院抗凝门诊接受稳定华法林治疗超过1个月且INR≥5的患者。记录30天的随访INR结果和结局。在148例患者中识别出195次抗凝过度事件。患者被分类为低风险（n = 85，57.4%）和中度出血风险（n = 63，42.6%）。平均初始INR为7.22（1.88）。与保守管理（n = 163，83.6%；P = 0.103）相比，低剂量口服维生素K管理（n = 32，16.4%）并未显著导致INR更快校正。随访INR检测平均在初始测量后的11.1（8.9）天进行。每次事件平均进行1.6（0.9）次随访INR检测。在30天随访期间，有1例（0.5%）大出血事件和1例（0.5%）死亡。无症状抗凝过度门诊患者的管理在30天内大出血风险较低。抗凝过度的保守管理与使用低剂量口服维生素K一样有效。
