Scardi S, Mazzone C
Centro Cardiovascolare Ospedale, Maggiore, Trieste.
G Ital Cardiol. 1998 Feb;28(2):178-86.
Anticoagulant therapy has recently undergone a surge in popularity with the confirmation of its importance in preventing cerebral thromboembolism from atrial fibrillation. Unfortunately oral anticoagulants have an extremely narrow therapeutic index and many physicians are reluctant to treat, particularly old patients, because of the fear of hemorrhagic complications and difficulty of management. The anticoagulant clinic, by improving therapeutic effectiveness and reducing complications, hospitalization and emergency room visits, appears to offer important qualitative and cost advantages over routine medical care. New strategies have been developed for managing care. One promising modality employs patients in their own care by performing their prothrombin time measurement by themselves at home. This model, similar to the way diabetics measure their own blood sugar, is possible as a result of a new class of point-of-care instrumentation for prothrombin testing. These portable monitors can measure a prothrombin time from a finger-stick sample of whole blood and provide a result within seconds. However rigorous studies are necessary to confirm the preliminary results of new management strategies to maximize the benefit-risk ratio of anticoagulant therapy.
随着抗凝治疗在预防房颤所致脑栓塞中的重要性得到证实，其近期受到了广泛关注。不幸的是，口服抗凝剂的治疗指数极窄，许多医生，尤其是老年患者，由于担心出血并发症和管理困难，不愿进行治疗。抗凝门诊通过提高治疗效果、减少并发症、住院次数和急诊就诊次数，似乎比常规医疗护理具有重要的质量和成本优势。已经开发出了新的护理管理策略。一种有前景的方式是让患者自行在家中进行凝血酶原时间测量，从而参与自身护理。这种模式类似于糖尿病患者自行测量血糖的方式，这得益于一类新型的即时检测凝血酶原检测仪器。这些便携式监测仪可以从手指采血的全血样本中测量凝血酶原时间，并在几秒钟内给出结果。然而，需要进行严格的研究来证实新管理策略的初步结果，以最大化抗凝治疗的效益风险比。
