Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.
Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.
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DOI：
10.1371/journal.pone.0095761
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Wuillemin WA
中科院分区：
文献类型：
--
作者：
Nagler M;Bachmann LM;Schmid P;Raddatz Müller P;Wuillemin WA
口服抗凝的患者自我管理(PSM)正在讨论中，因为缺乏来自现实生活环境的证据。使用瑞士一项全国性前瞻性队列研究的数据，我们评估了PSM的总体长期疗效和安全性，并检查了亚组。对1,140例患者(5818.9人年)的资料进行了分析，无一例失访。中位随访期为4.3年(0.2~12.8年)。接受培训时的中位年龄为54.2岁(18.2-85.2岁)，其中34.6%为女性。全因死亡率为每百人年1.4例(95%可信区间1.1-1.7)，房颤患者(2.5；1.6-3.7；P<；0.001)、50岁患者(2.0；1.6-2.6；P<；0.001)和男性(1.6；1.2-2.1；p = 0.036)的死亡率较高。血栓事件的发生率为0.4(0.2-0.6)，与适应症、性别和年龄无关。大出血发生率为1.1(0.9~1.5)个/100病人年。在网络荟萃分析中，疗效与标准护理和新的口服抗凝剂相当。经过适当训练的患者的PSM在长期的真实生活环境中是有效和安全的，并且在临床亚组中是健壮的。有必要在各种临床环境中采用，包括那些获得医疗保健的机会有限的地区或农村地区。
Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2–12.8 years). Median age at the time of training was 54.2 years (range 18.2–85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1–1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6–3.7; p<0.001), patients>50 years of age (2.0; 1.6–2.6; p<0.001), and men (1.6; 1.2–2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2–0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9–1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.
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影响因子：
10.4
作者：
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通讯作者：
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