心房颤动患者口服抗凝剂疗效指标选择的系统评价

万毅; 陈万; 李妮; 杜晓晗; 张玉海; 徐勇勇

心房颤动患者口服抗凝剂疗效指标选择的系统评价

Optimal measures of oral anticoagulation in atrial fibrillation: a systematic review

摘要

摘要: 目的: 了解心房颤动（房颤）患者口服抗凝剂治疗过程中抗凝效果的疗效观察指标应用情况，比较不同疗效观察指标的优缺点及适用性。方法: 运用Cochrane系统评价方法，检索MEDLINE，EMBASE和Cochrane Library 近10年（1998 年1月~2008年1月）关于口服抗凝剂（调整剂量华法林）疗效控制指标的文献进行系统评价。相关指标包括：在抗凝目标值范围内的时间百分比（percentage of time in therapeutic range，TTR），在抗凝目标值范围内的国际标准化比值(INR)百分比等。结果: 根据纳入排除标准入选文献50篇，共计68个研究组。研究样本量从25例到6 454例不等（平均757例）；研究或随访时间最短3个月，最长42个月（中位数12个月）。使用最多的抗凝控制指标为TTR［占研究总数69%（45/65）］和抗凝目标值范围内的INR百分比［占研究总数37%（24/65）］。仅有9%（6/65）的研究同时采用以上两种指标，两指标间差别有统计学意义［（59±13）% vs.(53±10)%，P=0.002］，同时有显著直线相关关系（r=0.988,P<0.001）。结论: TTR和抗凝目标值范围内的INR百分比是目前最常用的抗凝控制指标。相关研究可以同时采用这两种指标，并结合其他指标使用，以弥补相互不足便于抗凝监控和比较。

Abstract: AIM: To evaluate different measures of oral anticoagulation in patients with atrial fibrillation (AF) and to compare the application of different measures in clinical practice. METHODS: Evidence-based method was used to search MEDLINE, EMBASE and Cochrane Library (1998 to 2008) for studies (with adjusted dosage warfarin therapy) reporting international normalized ratio (INR) control measures as percentage of time in range (TTR), percentage of INRs in range, and percentage of patients in range and other same measures. RESULTS: Fifty publications with 68 study groups were identified. The sample size of studies was from 25 to 6 454 (mean 757). Duration or follow-up of studies was from 3-42 months (median: 12 months). TTR (69%) and percentage of INRs in range (37%) were the most popular measures. Only 9% of the total studies used both measures at the same time. A significant difference was found between the two measures ［(59±13)% vs.(53±10)%, P=0.002］, and a significant correlation was also found (r=0.988, P<0.001). CONCLUSION: TTR and percentage of INRs in range are the most popular measures used in anticoagulation control.

HTML全文

参考文献(0)

施引文献

资源附件(0)