中国房颤脑卒中患者使用罗伯特的年龄调整华法林负荷方案，可获得良好的 INR 治疗范围结果。
Chinese stroke patients with atrial fibrillation used Robert's age-adjusted warfarin loading protocol obtained good INR results within therapeutic range.
机构信息
Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China.
出版信息
Sci Rep. 2023 Oct 25;13(1):18230. doi: 10.1038/s41598-023-45379-7.
To assess whether Roberts' age-adjusted warfarin loading protocol is effective in Chinese patients and whether the SAMeTT2R2 score can predict international normalized ratio (INR) control. Roberts' protocol for warfarin titration was applied to patients with non-valvular atrial fibrillation (NVAF) complicated with ischemic stroke at the Department of Neurology between 2014 and 2019. Clinical and sociodemographic variables were recorded. A minimum of 1-year follow-up was used to calculate the time in therapeutic range (TTR) of the INR. A total of 94 acute ischemic stroke patients with NVAF were included in the study. Seventy-seven (81.9%) of the patients had attained stable INR (2.0-3.0) at the fifth dose, and 90.0% of the patients had achieved stable INR on the ninth day. Seventeen (18.1%) of the patients had an INR > 4 during dose-adjustment period. Patients with INR > 4 had significantly lower body weight (53.8 vs. 63.1 kg, P = 0.014), lower rate of achievement of stable INR (35.3% vs. 92.2%, P = 0.000), and lower rate of TTR ≥ 65% (23.5% vs. 70.1%, P = 0.001), but with no significant increase in bleeding risk. A total of 89 patients underwent long-term INR follow-up, of which 58 (65.2%) patients achieved TTR ≥ 65%. Patients with poor TTR had significantly lower body weight (56.3 vs. 63.7 kg, P = 0.020) and lower rate of stable INR achievement (64.5% vs. 89.7%, P = 0.002). All 94 patients had SAMeTT2R2 score ≥ 2. There was no linear association between SAMeTT2R2 score and the rate of TTR ≥ 65% (P = 0.095). Chinese ischemic stroke patients with NVAF on warfarin can safely and quickly achieve therapeutic INR using Roberts' age-adjusted protocol and can obtain a good TTR. Lower body weight may be a predictor of poor TTR and INR > 4. Patients who have not attained stable INR after adjusting the dose five times are at high risk for poor TTR. SAMeTT2R2 score may not predict TTR in Chinese ischemic stroke patients with NVAF.
目的 评估罗伯茨（Roberts）经年龄校正的华法林负荷方案是否适用于中国患者，以及 SAMeTT2R2 评分能否预测国际标准化比值（INR）控制情况。2014 年至 2019 年期间，神经内科应用罗伯茨经年龄校正的华法林滴定方案治疗非瓣膜性心房颤动（NVAF）合并缺血性脑卒中患者。记录患者的临床和社会人口统计学变量。采用最少 1 年的随访时间来计算 INR 的治疗范围时间（TTR）。共纳入 94 例 NVAF 合并急性缺血性脑卒中患者。第 5 次剂量调整时，77 例（81.9%）患者 INR 达到稳定（2.0-3.0），第 9 天 90.0%的患者 INR 达到稳定。在调整剂量期间，17 例（18.1%）患者 INR＞4。INR＞4 的患者体重明显较低（53.8 比 63.1kg，P＝0.014），稳定 INR 达标率较低（35.3%比 92.2%，P＝0.000），TTR≥65%的比例较低（23.5%比 70.1%，P＝0.001），但出血风险无明显增加。89 例患者进行了长期 INR 随访，其中 58 例（65.2%）患者 TTR≥65%。TTR 较差的患者体重明显较低（56.3 比 63.7kg，P＝0.020），稳定 INR 达标率较低（64.5%比 89.7%，P＝0.002）。所有 94 例患者的 SAMeTT2R2 评分均≥2。SAMeTT2R2 评分与 TTR≥65%的比例之间无线性关联（P＝0.095）。中国 NVAF 合并缺血性脑卒中患者使用罗伯茨经年龄校正的方案可安全、快速地达到治疗 INR，并获得良好的 TTR。较低的体重可能是 TTR 不良和 INR＞4 的预测因素。调整剂量 5 次后仍未达到稳定 INR 的患者，TTR 不良的风险较高。SAMeTT2R2 评分可能不能预测中国 NVAF 合并缺血性脑卒中患者的 TTR。
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