McCormack P M, Stinson J C, Hemeryck L, Feely J
Department of Therapeutics and Pharmacoepidemiology, Trinity Centre for Health Sciences, St James's Hospital, Dublin.
Ir Med J. 1997 Aug-Sep;90(5):192-3.
Oral anti-coagulation with warfarin is increasingly required in the prophylaxis and treatment of vascular thrombosis and embolism. Unless the degree of anti-coagulation is maintained in the narrow therapeutic range either serious bleeding or failure to prevent thromboembolism may occur. Complications may occur in up to 31% of patients. We randomly sampled 50 patients attending an anticoagulant clinic and interviewed them. We found the PTR between 2.0-4.0 in 70% patients. Their records indicated that they attended 0.9 +/- 0.5 times per month, but the patients themselves said that they had 2.4 +/- 1.7 visits per month, lasting on average 1.9 +/- 0.7 hours per visit. The mean duration of therapy was 4.3 +/- 5.4 years [range 1 month to 26 years]. Many patients perceived that they had received no education about warfarin (23%) while the majority 67% of the remainder said their doctor had educated them. Concomitant aspirin was avoided by 74% patients but 14% considered it safe in combination with warfarin; 49% patients believed that alcohol was safe in combination with warfarin. When asked about the colours and strengths of warfarin tablets, 37% of our sample were completely correct, 9% were completely incorrect and 54% were partly correct. In 16% patients they could not describe their current therapy. As doctors may adjust warfarin dosage for patients in terms of tablet colour, we asked a sample of junior doctors about the colours or strengths of warfarin tablets: 10% were completely correct, one doctor knew none of the colours or strengths and the remainder had a partial knowledge. These studies suggest that the majority of patients on warfarin are cautious about therapy and are safe in their practices. However, we feel that a significant minority may be at risk from complications because of inadequate knowledge. We suggest that improving patient understanding by education may reduce complications and lead to more stable control of anticoagulant therapy.
在血管血栓形成和栓塞的预防及治疗中，使用华法林进行口服抗凝治疗的需求日益增加。除非抗凝程度维持在狭窄的治疗范围内，否则可能会发生严重出血或无法预防血栓栓塞。高达31%的患者可能会出现并发症。我们随机抽取了50名到抗凝门诊就诊的患者并对他们进行了访谈。我们发现70%的患者凝血酶原时间比值（PTR）在2.0至4.0之间。他们的记录显示，他们每月就诊0.9±0.5次，但患者自己表示每月就诊2.4±1.7次，每次就诊平均持续1.9±0.7小时。平均治疗时长为4.3±5.4年（范围为1个月至26年）。许多患者认为他们未接受过关于华法林的教育（23%），而其余大部分（67%）表示他们的医生对他们进行过教育。74%的患者避免同时使用阿司匹林，但14%的患者认为阿司匹林与华法林联合使用是安全的；49%的患者认为酒精与华法林联合使用是安全的。当被问及华法林片剂的颜色和规格时，我们样本中的37%回答完全正确，9%完全错误，54%部分正确。16%的患者无法描述他们当前的治疗情况。由于医生可能会根据片剂颜色为患者调整华法林剂量，我们询问了一组低年资医生关于华法林片剂的颜色或规格：10%回答完全正确，一名医生对颜色和规格一无所知，其余医生了解部分信息。这些研究表明，大多数服用华法林的患者对治疗持谨慎态度，并且做法安全。然而，我们认为有相当一部分少数患者可能因知识不足而面临并发症风险。我们建议通过教育提高患者的认知，这可能会减少并发症，并使抗凝治疗得到更稳定的控制。
