Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand.
Thromb Haemost. 2022 Apr;122(4):492-505. doi: 10.1055/a-1677-9608. Epub 2022 Jan 20.
To compare the effects of different strategies for warfarin self-care.
PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and OpenGrey were searched from inception to August 2021. Randomized controlled trials (RCTs) of warfarin self-care, either patient self-testing (PST) or patient self-management (PSM), were included. Self-care approaches were classified based on the TIP framework (theme, intensity, provider): (1) PST ≥1/week via e-Health (PST/High/e-Health); (2) PST ≥1/week by health care practitioner (PST/High/HCP); (3) PST <1/week via e-Health (PST/Low/e-Health); (4) PSM ≥1/week by e-Health (PSM/High/e-Health); (5) PSM ≥1/week by patient (PSM/High/Pt); (6) PSM <1/week by patient (PSM/Low/Pt); and (7) PSM with flexible frequency by patient (PSM/Flex/Pt). Mean differences (MDs) and risk ratios (RRs) with 95% confidence interval (CI) were estimated using frequentist network meta-analyses with a random-effects model. The certainty of evidence was evaluated using CINeMA (Confidence in Network Meta-Analysis).
Sixteen RCTs involving 5,895 participants were included. When compared with usual care, time in therapeutic range was higher in PSM/High/Pt and PST/High/e-Health with MD [95% CI] of 7.67% [0.26-15.08] and 5.65% [0.04-11.26], respectively. The certainty of evidence was rated as moderate for these findings. The risk of thromboembolic events was lower in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39 [0.20-0.77]) and usual care (RR: 0.38 [0.17-0.88]) with low and very low level of evidence, respectively. There was no significant difference in the proportion of international normalized ratio (INR) values in range, major bleeding, and all-cause mortality among different self-care features.
Patient self-care (either PST or PSM) by measuring INR values at least once weekly is more effective in controlling the INR level.
比较华法林自我护理的不同策略的效果。
检索了PubMed、EMBASE、CENTRAL、CINAHL、ProQuest Dissertations & Theses 和 OpenGrey 数据库，检索时间从建库至 2021 年 8 月。纳入了关于华法林自我护理（患者自我检测（PST）或患者自我管理（PSM））的随机对照试验（RCT）。根据 TIP 框架（主题、强度、提供者）对自我护理方法进行分类：（1）通过电子医疗（PST/高/e-Health）每周至少进行 1 次 PST；（2）由医疗保健从业者（PST/高/HCP）每周至少进行 1 次 PST；（3）通过电子医疗（PST/低/e-Health）每周进行 PST 少于 1 次；（4）通过电子医疗（PSM/高/e-Health）每周至少进行 1 次 PSM；（5）由患者（PSM/高/Pt）每周至少进行 1 次 PSM；（6）由患者（PSM/低/Pt）每周 PST 少于 1 次；（7）由患者（PSM/ Flex/Pt）灵活频率的 PSM。使用随机效应模型的频率网络荟萃分析估计均值差（MD）和风险比（RR）及其 95%置信区间（CI）。使用 CINeMA（网络荟萃分析的置信度）评估证据的确定性。
纳入了 16 项涉及 5895 名参与者的 RCT。与常规护理相比，PSM/高/Pt 和 PST/高/e-Health 组的治疗范围内时间更高，MD[95%CI]分别为 7.67%[0.26-15.08]和 5.65%[0.04-11.26]。这些发现的证据确定性被评为中度。与 PST/高/e-Health（RR：0.39[0.20-0.77]）和常规护理（RR：0.38[0.17-0.88]）相比，PSM/Flex/Pt 组的血栓栓塞事件风险较低，证据水平分别为低和极低。不同自我护理特征之间的 INR 值范围、大出血和全因死亡率的国际标准化比值（INR）值比例没有显著差异。
每周至少测量一次 INR 值的患者自我护理（无论是 PST 还是 PSM）在控制 INR 水平方面更有效。
