Smith Shannon, Hogan Angela R, Richow Wendy
Methodist Richardson Medical Center, Richardson, TX, USA.
Maxor National Pharmacy Services Corp, Amarillo, TX, USA.
Hosp Pharm. 2024 Dec 7:00185787241303914. doi: 10.1177/00185787241303914.
This study examines the correlation between time-in-therapeutic range (TTR) and anticoagulation-related adverse events (AEs) in patients with atrial fibrillation (Afib) in a pharmacist-managed ambulatory care clinic. A single-center, retrospective cohort study was conducted at a community hospital-based outpatient anticoagulation clinic to investigate the predictive value of suboptimal TTR percentages for hemorrhagic or thromboembolic events in Afib patients. Eligible participants were aged 18 years or older, diagnosed with Afib, and receiving warfarin therapy as current or past enrollees in the anticoagulation management program. Patients seen at the clinic between April 2017 and June 2023 were included and categorized into 2 groups based on their TTR: TTR < 65% or TTR ≥ 65%. The primary outcome assessed was the TTR achieved by clinic patients. Secondary outcomes included the duration of warfarin therapy, percentage of thromboembolic events, percentage of hemorrhagic events, CHADs-VASc score, HAS-BLED score, and reasons documented for suboptimal TTR. A total of 193 patients were included, with an average TTR of 66.17%. Baseline characteristics were similar between groups. Five patients in the TTR < 65% group and 3 in the TTR ≥ 65% group ( = .391) experienced thromboembolic events; 19 and 15 patients ( = .291) experienced hemorrhagic events, respectively. Those with TTR ≥ 65% had longer warfarin durations and lower HAS-BLED scores. CHADs-VASc scores were comparable. Main reasons for suboptimal TTR included drug-drug interactions, missed warfarin doses, dietary vitamin K intake changes, held warfarin doses, and incorrect warfarin dosing. This study found that at an outpatient pharmacist-managed anticoagulation clinic, the average TTR for atrial fibrillation patients with an INR goal range of 2 to 3 was greater than 65%. Additionally, there were no differences in bleeding or stroke events for patients whose TTR < 65% when compared to those patients whose TTR was ≥ 65%.
本研究在一家由药剂师管理的门诊护理诊所中，考察了心房颤动（房颤）患者的治疗范围内时间（TTR）与抗凝相关不良事件（AE）之间的相关性。在一家社区医院的门诊抗凝诊所进行了一项单中心回顾性队列研究，以调查次优TTR百分比对房颤患者出血或血栓栓塞事件的预测价值。符合条件的参与者年龄在18岁及以上，诊断为房颤，并且作为抗凝管理项目的当前或既往参与者接受华法林治疗。纳入了2017年4月至2023年6月期间在该诊所就诊的患者，并根据其TTR分为两组：TTR＜65%或TTR≥65%。评估的主要结局是诊所患者达到的TTR。次要结局包括华法林治疗时长、血栓栓塞事件百分比、出血事件百分比、CHADs-VASc评分、HAS-BLED评分以及记录的次优TTR的原因。共纳入193例患者，平均TTR为66.17%。两组之间的基线特征相似。TTR＜65%组有5例患者、TTR≥65%组有3例患者（P = 0.391）发生血栓栓塞事件；分别有19例和15例患者（P = 0.291）发生出血事件。TTR≥65%的患者华法林治疗时长更长，HAS-BLED评分更低。CHADs-VASc评分相当。次优TTR的主要原因包括药物相互作用、华法林漏服、饮食中维生素K摄入量变化、华法林剂量停用以及华法林剂量错误。本研究发现，在一家由门诊药剂师管理的抗凝诊所中，国际标准化比值（INR）目标范围为2至3的房颤患者的平均TTR大于65%。此外，TTR＜65%的患者与TTR≥65%的患者相比，出血或中风事件并无差异。
