治疗范围内时间（TTR）：一个过度简化的难题。
Time in the Therapeutic Range (TTR): An Overly Simplified Conundrum.
作者信息
Reiffel James A
机构信息
Professor Emeritus of Medicine, Columbia University.
出版信息
J Innov Card Rhythm Manag. 2017 Mar 15;8(3):2643-2646. doi: 10.19102/icrm.2017.080302. eCollection 2017 Mar.
Abstract
Anticoagulation with warfarin has been used for over 60 years; however, its administration is fraught with difficulty since many factors can affect warfarin dosing. The concept of time in therapeutic range (TTR) has become a popular way to report warfarin management and compare anticoagulation management across clinical trials. However, TTR is a much more complex concept than most clinicians and trialists recognize. This manuscript attempts to discuss some of the important factors underlying this complexity and presents a suggestion to improve reports on TTR.
摘要
华法林抗凝治疗已应用超过60年；然而，由于许多因素会影响华法林的剂量，其应用充满困难。治疗范围内时间（TTR）的概念已成为一种常用的报告华法林治疗管理情况以及在临床试验中比较抗凝治疗管理情况的方式。然而，TTR是一个比大多数临床医生和试验者所认识到的更为复杂的概念。本文试图探讨造成这种复杂性的一些重要因素，并提出改进TTR报告的建议。
相似文献
1
Time in the Therapeutic Range (TTR): An Overly Simplified Conundrum.治疗范围内时间（TTR）：一个过度简化的难题。
J Innov Card Rhythm Manag. 2017 Mar 15;8(3):2643-2646. doi: 10.19102/icrm.2017.080302. eCollection 2017 Mar.
2
Warfarin anticoagulation in hemodialysis patients with atrial fibrillation: comparison of nephrologist-led and anticoagulation clinic-led management.血液透析合并心房颤动患者的华法林抗凝治疗：肾科医生主导与抗凝门诊主导管理的比较
BMC Nephrol. 2018 Jan 8;19(1):4. doi: 10.1186/s12882-017-0809-x.
3
Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin.药学服务可增加华法林抗凝质量不佳患者处于治疗范围内的时间。
Front Pharmacol. 2018 Sep 21;9:1052. doi: 10.3389/fphar.2018.01052. eCollection 2018.
5
Time in Therapeutic Range and Outcomes After Warfarin Initiation in Newly Diagnosed Atrial Fibrillation Patients With Renal Dysfunction.新诊断的肾功能不全房颤患者启动华法林治疗后的治疗范围内时间及结局
J Am Heart Assoc. 2017 Mar 1;6(3):e004925. doi: 10.1161/JAHA.116.004925.
6
7
Variation in warfarin dose adjustment practice is responsible for differences in the quality of anticoagulation control between centers and countries: an analysis of patients receiving warfarin in the randomized evaluation of long-term anticoagulation therapy (RE-LY) trial.华法林剂量调整实践的差异是导致不同中心和国家抗凝控制质量差异的原因：RE-LY 试验中接受华法林治疗的患者分析。
Circulation. 2012 Nov 6;126(19):2309-16. doi: 10.1161/CIRCULATIONAHA.112.101808. Epub 2012 Oct 1.
8
Warfarin utilisation and anticoagulation control in patients with atrial fibrillation and chronic kidney disease.心房颤动合并慢性肾脏病患者的华法林使用及抗凝控制
Heart. 2017 Jun;103(11):818-826. doi: 10.1136/heartjnl-2016-309266. Epub 2016 Nov 15.
9
Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall schedule on time in therapeutic range.心房颤动的抗凝管理：给药算法和召回计划对处于治疗范围内时间的影响。
Fam Pract. 2015 Oct;32(5):514-9. doi: 10.1093/fampra/cmv066. Epub 2015 Aug 5.
10
Individual and monitoring centre influences upon anticoagulation control of AF patients on warfarin: A longitudinal multi-centre UK-based study.个体和监测中心对服用华法林的房颤患者抗凝控制的影响：一项基于英国的纵向多中心研究。
Eur J Haematol. 2018 Oct;101(4):486-495. doi: 10.1111/ejh.13130. Epub 2018 Aug 3.
引用本文的文献
1
The Application of Machine Learning in Warfarin Dose Precision for Diabetic Patients Treated with Statins: A Comparative Study.机器学习在接受他汀类药物治疗的糖尿病患者华法林剂量精准化中的应用：一项对比研究。
Cardiovasc Drugs Ther. 2025 May 31. doi: 10.1007/s10557-025-07690-5.
2
Reduced dose direct oral anticoagulants and time-in-therapeutic-range defined warfarin in new-onset atrial fibrillation: a report from the nationwide FinACAF study.低剂量直接口服抗凝剂与治疗范围内时间定义的华法林用于新发房颤：来自全国性芬兰房颤研究（FinACAF）的报告
Eur Heart J Open. 2025 Apr 23;5(3):oeaf046. doi: 10.1093/ehjopen/oeaf046. eCollection 2025 May.
3
[Educational program to improve knowledge and therapeutic range for self-controlled anticoagulated patients].
Aten Primaria. 2025 May;57(5):103139. doi: 10.1016/j.aprim.2024.103139. Epub 2024 Nov 12.
4
Effectiveness of a self-management program for anticoagulated patients to improve their knowledge about treatment and time in therapeutic range.抗凝治疗患者自我管理方案对提高其治疗相关知识和治疗达标时间的效果。
Medicine (Baltimore). 2024 Nov 1;103(44):e40258. doi: 10.1097/MD.0000000000040258.
5
Time in Therapeutic Range of Unfractionated Heparin-Based Therapy in Critically Ill Patients with COVID-19 Pneumonia.新型冠状病毒肺炎危重症患者普通肝素治疗的治疗窗时间
Ther Clin Risk Manag. 2024 Sep 10;20:611-618. doi: 10.2147/TCRM.S476187. eCollection 2024.
6
Cost-Effectiveness Analysis of Pharmacogenomics-Guided Versus Standard Dosing of Warfarin in Patients with Mechanical Prosthetic Heart Valve.机械人工心脏瓣膜患者中，华法林药物基因组学指导剂量与标准剂量的成本效益分析。
Iran J Pharm Res. 2024 May 14;23(1):e143898. doi: 10.5812/ijpr-143898. eCollection 2024 Jan-Dec.
7
Tacrolimus's Time Below Therapeutic Range Is Associated With Acute Pancreatic Graft Rejection and the Development of Donor-specific Antibodies.他克莫司治疗窗浓度以下与急性胰腺移植物排斥和供体特异性抗体的产生有关。
Transpl Int. 2024 Apr 17;37:12591. doi: 10.3389/ti.2024.12591. eCollection 2024.
8
Combined effect of time in target range and variability of systolic blood pressure on cardiovascular outcomes and mortality in patients with hypertension: A prospective cohort study.目标范围内时间和收缩压变异性对高血压患者心血管结局和死亡率的联合影响：一项前瞻性队列研究。
J Clin Hypertens (Greenwich). 2024 Jun;26(6):714-723. doi: 10.1111/jch.14816. Epub 2024 Apr 23.
9
A Novel Nomogram for Predicting Warfarin-Related Bleeding: A Retrospective Cohort Study.一种预测华法林相关出血的新型列线图：一项回顾性队列研究。
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241234894. doi: 10.1177/10760296241234894.
10
Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study.耳鼻咽喉科手术中气管内导管套囊的压力变化：一项前瞻性观察研究。
Front Med (Lausanne). 2023 Jun 5;10:1161566. doi: 10.3389/fmed.2023.1161566. eCollection 2023.
本文引用的文献
1
Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry.美国心房颤动患者服用华法林的治疗范围内时间：来自ORBIT-AF注册研究的结果。
Am Heart J. 2015 Jul;170(1):141-8, 148.e1. doi: 10.1016/j.ahj.2015.03.017. Epub 2015 Apr 1.
2
Relationship between time in therapeutic range and comparative treatment effect of rivaroxaban and warfarin: results from the ROCKET AF trial.利伐沙班与华法林在治疗范围内的时间与比较治疗效果之间的关系：ROCKET AF试验结果
J Am Heart Assoc. 2014 Apr 22;3(2):e000521. doi: 10.1161/JAHA.113.000521.
3
Edoxaban versus warfarin in patients with atrial fibrillation.依度沙班与华法林用于房颤患者。
N Engl J Med. 2013 Nov 28;369(22):2093-104. doi: 10.1056/NEJMoa1310907. Epub 2013 Nov 19.
4
Impact of global geographic region on time in therapeutic range on warfarin anticoagulant therapy: data from the ROCKET AF clinical trial.全球地理区域对华法林抗凝治疗治疗范围内时间的影响：来自 ROCKET AF 临床试验的数据。
J Am Heart Assoc. 2013 Feb 19;2(1):e000067. doi: 10.1161/JAHA.112.000067.
5
Apixaban versus warfarin in patients with atrial fibrillation.阿哌沙班与华法林用于房颤患者。
N Engl J Med. 2011 Sep 15;365(11):981-92. doi: 10.1056/NEJMoa1107039. Epub 2011 Aug 27.
6
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.利伐沙班与华法林用于非瓣膜性心房颤动。
N Engl J Med. 2011 Sep 8;365(10):883-91. doi: 10.1056/NEJMoa1009638. Epub 2011 Aug 10.
7
An important indirect drug interaction between dronedarone and warfarin that may be extrapolated to other drugs that can alter gastrointestinal function.
Am Heart J. 2011 Feb;161(2):e5; author reply e7. doi: 10.1016/j.ahj.2010.11.013.
8
Dabigatran versus warfarin in patients with atrial fibrillation.达比加群与华法林用于房颤患者的比较。
N Engl J Med. 2009 Sep 17;361(12):1139-51. doi: 10.1056/NEJMoa0905561. Epub 2009 Aug 30.
9
Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States.评估美国心房颤动患者华法林控制质量的荟萃分析。
J Manag Care Pharm. 2009 Apr;15(3):244-52. doi: 10.18553/jmcp.2009.15.3.244.
10
Determinants and measures of quality in oral anticoagulation therapy.口服抗凝治疗的质量决定因素及衡量标准。
J Thromb Thrombolysis. 2008 Feb;25(1):61-6. doi: 10.1007/s11239-007-0106-9. Epub 2007 Sep 29.
Zotero 插件