JAMA：大部分接受华法林治疗的患者未能随时间推移维持稳定的国际标准化比值

2016-08-13 MedSci MedSci原创

据发表于JAMA的一项研究表明，大部分接受华法林治疗的患者未能随时间推移维持稳定的国际标准化比值（INR）。该研究发现挑战了人们的一贯看法：华法林预后好的患者应继续使用华法林而不应换成非维生素K口服抗凝药。华法林可大大降低房颤患者卒中的发生风险，但是其治疗窗很窄（INR值，2.0-3.0），且与食物和药物相互作用有关。非维生素K口服抗凝药不需要药物检测，且与华法林的效果及安全性相似，甚至可

据发表于JAMA的一项研究表明，大部分接受华法林治疗的患者未能随时间推移维持稳定的国际标准化比值（INR）。该研究发现挑战了人们的一贯看法：华法林预后好的患者应继续使用华法林而不应换成非维生素K口服抗凝药。

华法林可大大降低房颤患者卒中的发生风险，但是其治疗窗很窄（INR值，2.0-3.0），且与食物和药物相互作用有关。非维生素K口服抗凝药不需要药物检测，且与华法林的效果及安全性相似，甚至可能优于华法林，但是价格较华法林更贵。关于既往一直服用华法林的患者是否应该改为非维生素K口服抗凝药一直存在争议。

该研究共纳入了来自美国176家诊所的3749名服用华法林的房颤患者，平均年龄为75岁，43%为女性，治疗后前6个月仅26%的患者能保持至少80%的INR在2.0-3.0之间。这些患者中，仅34%的患者能在下一年中仍稳定的NIRs。

无论患者基线时期INR是否稳定对后一年是否仍可保持稳定并无太大的预测价值。研究开始时80%及以上INR处于目标范围内的患者中， 36%的患者在下一年中至少有一次极端INR。

该研究的局限性在于设定目标INR为2.0-3.0时由于出血或更高的机械阈值医生可以获得更低的INR值。

总而言之，该研究表明，华法林的长期稳定性很难预测，且质疑了这一看法：既往的服用华法林INR稳定的患者应继续服用华法林。

原始出处：

Jacqui Wise. Most patients taking warfarin do not maintain stable INR values. BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i4402

Pokorney S, Simon D, Thomas L, et al. Stability of international normalized ratios in patients taking long-term warfarin therapy. JAMA2016. doi:10.1001/jama.2016.9356.

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2016-09-19 108807375_62823139

#标准化#

94 0
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2016-09-10 tigerlr98

#国际标准#

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2016-10-09 ylzr123

好文，从这里学习了好多新知识，新信息。赞了！

126 0
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2016-09-25 1e10c84am36(暂无匿称)

文章很好值得关注

135 0
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2016-09-03 李东泽

很好，不错，以后会多学习

98 0
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2016-08-28 stead

学习到了

89 0
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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Aug 22 21:14:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100956, encodeId=456e100956cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:49:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100762, encodeId=c0dc100e6241, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Fri Aug 19 09:24:00 CST 2016, time=2016-08-19, status=1, ipAttribution=)]
2016-08-28 stead

学习到了

0 0
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2016-08-22 医路开来

学习啦，。。。

78 0
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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Aug 22 21:14:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100956, encodeId=456e100956cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:49:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100762, encodeId=c0dc100e6241, 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2016-08-19 136****0753赵

值得学习

56 0
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2016-08-19 1e0daa8am11(暂无匿称)

继续学习

98 0