Patient self-monitoring of oral anticoagulant therapy: potential benefits and implications for clinical practice.
Patient self-monitoring of oral anticoagulant therapy: potential benefits and implications for clinical practice.
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DOI：
10.2165/00129784-200101040-00003
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发表时间：
2001-01-01
期刊：
影响因子：
--
通讯作者：
Douketis, J D
中科院分区：
文献类型：
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作者：
Douketis, J D
香豆素衍生物是广泛用于慢性房颤、静脉血栓栓塞、心脏瓣膜病、心肌梗死或机械人工心脏瓣膜患者的口服抗凝剂。由于香豆素类药物的治疗窗较窄，且可能发生药物相互作用，因此需要频繁监测抗凝治疗，以将大多数临床适应症的国际标准化比值（INR）维持在2.0 - 3.5之间。口服抗凝治疗的监测给医疗保健提供者带来了相当大的负担，因为许多患者需要香豆素类药物的终身治疗，并且越来越多的老年患者接受香豆素类药物治疗。一种新的方法，可能，部分地，解决这一医疗保健需求是患者自我监测抗凝与便携式凝血仪。几项队列研究和随机对照试验发现，抗凝自我监测与专业抗凝诊所或全科医生的常规监测一样好，甚至更好。抗凝自我监测的优势包括减少与抗凝门诊访视和华法林治疗的实验室监测相关的患者不便，以及如果通过抗凝自我监测更频繁地进行INR测量，则INR水平更少超出治疗INR范围。因此，抗凝自我监测有可能降低接受长期口服抗凝治疗的患者的血栓栓塞和出血事件的发生率。抗凝自我监测的潜在缺点包括便携式凝血仪的成本。此外，自我监测仅限于具有认知和身体能力来执行便携式凝血仪所需技术的患者。
Coumarin derivatives are widely used oral anticoagulants for patients with chronic atrial fibrillation, venous thromboembolism, valvular heart disease, myocardial infarction or a mechanical prosthetic heart valve. Because of the narrow therapeutic window associated with coumarins and the potential for drug interactions, frequent monitoring of anticoagulation is required to maintain the International Normalized Ratio (INR) between 2.0 to 3.5 for most clinical indications. Monitoring of oral anticoagulant therapy is placing a considerable burden on healthcare providers because many patients require life-long treatment with coumarins, and because of an increasing number of elderly patients with conditions that are treated with coumarins. A novel approach that might, in part, address this healthcare need is patient self-monitoring of anticoagulation with a portable coagulometer. Several cohort studies and randomized controlled trials have found that anticoagulation self-monitoring is as good as, or better than, conventional monitoring in a specialized anticoagulation clinic or by a general practitioner. The advantages of anticoagulation self-monitoring include reduced patient inconvenience relating to anticoagulation clinic visits and laboratory monitoring of warfarin therapy, and fewer INR levels outside the therapeutic INR range if INR measurements are preformed more frequently with anticoagulation self-monitoring. Thus, anticoagulation self-monitoring has the potential to reduce the incidence of thromboembolic and bleeding episodes in patients who are receiving long term oral anticoagulant therapy. The potential drawbacks of anticoagulation self-monitoring include the costs of the portable coagulometer. Additionally, self-monitoring is limited to patients who have the cognitive and physical capabilities to perform the technique required for the portable coagulometer.