Self-management program improves anticoagulation control and quality of life: a prospective randomized study
Self-management program improves anticoagulation control and quality of life: a prospective randomized study
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DOI：
10.1016/j.ejcts.2008.10.020
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发表时间：
2009-02-01
影响因子：
3.4
通讯作者：
van Straten, Albert H. M.
中科院分区：
文献类型：
--
作者：
Hamad, Mohamed A. Soliman;van Eeketen, Ellen;van Straten, Albert H. M.
目的：以往的回顾性研究表明，患者对口服抗凝剂的自我管理可提高控制率。在这项前瞻性随机研究中，我们调查了自我管理对抗凝治疗控制和生活质量的影响。与通过荷兰血栓服务的传统管理进行了比较。方法：2005年1月至2007年6月，62例择期机械瓣膜置换术患者纳入本研究。患者被随机分为两组：(1)由当地血栓服务中心控制的传统组，(2)使用CoaguChek(注册商标)的自我管理组。主要终点也是目标范围内的国际标准化比率(INR)值的总数。作为术后1年的生活质量测评(SF-36V2)(R)。结果：自我管理组INR值在目标范围(2.5~4.5)的个数(平均值=72.9±11%)显著高于常规组(53.9+/-14%；P=0.01)。术后一年，两组患者的生活质量评分均有改善。然而，在自我管理组中，仅就身体成分总结而言，术后的改善在统计学上是显著的(p=0.001)。结论：尽管荷兰血栓管理局对INR进行了组织严密的控制，但经过充分培训后的自我管理计划改善了INR的控制。术后生活质量评分的改善在自我管理组仅就身体成分总结而言是显著的。需要进一步的研究来描述自我管理计划是否会降低出血和/或血栓栓塞症的风险。(C)2008年欧洲胸心外科协会。出版：Elsevier B.V.All。版权保留。
Objective: Previous retrospective studies suggest that patients' self management of oral anticoagulants leads to improved control. In this prospective randomized study, we investigated the effects of self management on the control of anticoagulant therapy and quality of life. Comparison with the conventional management through the Dutch Thrombosis Service is addressed. Methods: Between January 2005 and June 2007, 62 consecutive patients who underwent elective mechanical aortic valve replacement were included in this study. Patients were randomized into two groups: (1) conventional group controlled by the Local Thrombosis Service, and (2) self management group using CoaguChek (R). Primary endpoints were the total number of international normalized ratio (INR) values within the target range as well. as the quality of life measurements (SF-36v2)(R) one year postoperatively. Results: The number of INR values within the target range (2.5-4.5) was significantly higher in the self management group (mean = 72.9 + 11%) than in the conventional group (53.9 +/- 14%; p = 0.01). Both groups showed an improvement in the quality of life scores one year postoperatively. However, postoperative improvement was statistically significant in the self management group regarding the physical component summary only (p = 0.001). Conclusion: Despite the well-organized INR control by the Thrombosis Service in The Netherlands, self management program after adequate training improves the INR control. Postoperative improvement in the quality of life scores was significant in the self management group with regards to the physical component summary only. Further studies are needed to describe whether self management program will reduce the risk of bleeding and/or thrombo-embolism. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All. rights reserved.