Charney R, Leddomado E, Rose D N, Fuster V
Department of Community Medicine, Mount Sinai, School of Medicine New York, New York.
Int J Cardiol. 1988 Feb;18(2):197-206. doi: 10.1016/0167-5273(88)90165-9.
Patients attending an anticoagulation clinic were studied to delineate predisposing risk factors for bleeding and thromboembolic episodes. Seventy-three patients were observed for a total of 921.8 patient-treatment months. The mean duration of treatment was 12.6 months (range 3-36 months). No major bleed occurred (a bleed which caused discontinuation of therapy, hospitalization or death). Thirty-two patients had minor bleeding episodes (0.42 bleeds per patient-year of treatment). The average prothrombin time ratio during the third to the sixth month of therapy was predictive of the bleeding risk. There was no association between bleeding and age, sex, indication for anticoagulation therapy or associated illnesses. Four thromboembolic episodes occurred (0.05 per patient-year of treatment), 3 arterial and 1 venous. At the time of the one venous thromboembolic event the prothrombin time ratio was subtherapeutic. In all 3 patients with arterial thromboembolism the mean 3- to 6-month prothrombin time ratio was less than or equal to the lower limit of the recommended range of 1.6-2.5. In our study prothrombin time ratios of 1.3-1.5 for venous thromboembolic disease and 1.6-2.5 for arterial thromboembolic disease were not associated with thromboembolism or major bleeding. Anticoagulation clinics facilitate the close monitoring of patients on oral anticoagulant therapy.
对在抗凝门诊就诊的患者进行了研究，以确定出血和血栓栓塞事件的诱发危险因素。共观察了73例患者，总计921.8个患者治疗月。平均治疗时长为12.6个月（范围3 - 36个月）。未发生大出血事件（导致治疗中断、住院或死亡的出血）。32例患者出现轻微出血事件（每患者治疗年0.42次出血）。治疗第三个月至第六个月期间的平均凝血酶原时间比值可预测出血风险。出血与年龄、性别、抗凝治疗指征或相关疾病之间无关联。发生了4次血栓栓塞事件（每患者治疗年0.05次），3次为动脉血栓栓塞，1次为静脉血栓栓塞。发生静脉血栓栓塞事件时，凝血酶原时间比值低于治疗水平。在所有3例动脉血栓栓塞患者中，3至6个月的平均凝血酶原时间比值小于或等于推荐范围1.6 - 2.5的下限。在我们的研究中，静脉血栓栓塞疾病的凝血酶原时间比值为1.3 - 1.5，动脉血栓栓塞疾病的凝血酶原时间比值为1.6 - 2.5，与血栓栓塞或大出血无关。抗凝门诊有助于对接受口服抗凝治疗的患者进行密切监测。
