心房纤颤患者华法林治疗INR即时检测技术的临床分析

Clinical Analysis of INR of Warfarin Obtained by Point of Care Testing Technology in the Treatment of Patients with Atrial Fibrillation

目的:评价我国应用华法林治疗心房纤颤(atrial fibrillation,AF)患者采用即时检测技术(point of care test,POCT)监测国际标准化比值(International Normalised Ratio,INR))的可行性.方法:选取北京市昌平区医院2016年6月-12月心血管门诊非瓣膜病AF患者,CHA2DS2评分≥2分的132例患者作为对照组,自愿口服华法林16例,采用化验室检测INR;选取2017年1月-6月房颤抗凝门诊就诊的非瓣膜病AF患者,CHA2DS2评分≥2分的145例作为观察组,自愿口服华法林50例,采用Coagu Chek XS(Roche)便携式血凝仪检测INR.两组均设定INR 2-3为目标值,对比观察两组华法林使用率、检验转周期(turnaround time,TAT)、在抗凝目标值范围内的INR百分比(time within therapeutic INR target range,TTR),随访6个月不良事件发生率.结果:房颤抗凝门诊华法林使用率、TTR均高于心血管门诊,TAT显著缩短,POCT能节约检测时间(P<0.05),两组不良事件发生率无统计学意义(P>0.05).结论:房颤抗凝门诊可进一步提高非瓣膜病AF患者华法林抗凝治疗率和效果,POCT简便、快捷,能节约患者复查所需时间,提高华法林抗凝治疗的依从性、有效性、安全性,在我国值得推广.

Objective:To evaluate the effect of using point of care test(POCT)to monitor the international normalised ratio(INR)of warfarin in the treatment of atrial fibrillation(AF)patients in China.Methods:132 patients with non-valvular AF and the CHA2DS2 score≥2 in the cardiovascular clinic of our hospital between June to December 2016 were selected as the control group.16 cases of the 132 patients were given oral warfarin voluntarily and the INR was detected by laboratory examination.145 patients with non-valvular AF and CHA2DS2 score≥2 in the anticoagulation clinic of our hospital between January to June in 2017 were selected as the observation group.50 cases of the 145 patients were given oral warfarin voluntarily and the INR was detected by Coagu Chek XS(Roche)portable coagulometer.Setting INR 2-3 as the target value in both groups,we compared the application rate of warfarin,turnaround time(TAT)and the time within therapeutic INR target range(TTR)and followed up the adverse event rate in the range of the anticoagulant target for 6 months between the two groups.Results:The application rate of warfarin and TTR of the anticoagulantion clinic was higher than that of the cardiovascular clinic,the TAT was shortened significantly,and the POCT could save the detection time(P<0.05).The incidence of adverse events in two groups was not statistically significant(P>0.05).Conclusion:The anticoagulantion clinic can further improve the anticoagulant treatment rate and effect of warfarin in treatment of non-valvular AF patients.POCT is convenient and quick,can save the patient’review time;improve anticoagulant treatment compliance,effectiveness and safety,so it has a good application prospects in China.