基于ROC曲线预测华法林治疗患者抗凝强度的研究
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摘要
探讨华法林治疗患者起始国际标准化比值(INR)预测抗凝强度未达标的能力。纳入108例华法林治疗患者,予华法林2.5 mg/d治疗2 d后晨起检测起始INR值,并于服药7 d后重复检测稳态INR值,INR<2定义为抗凝强度未达标。利用受试者工作曲线(ROC curve)检验起始INR值对华法林抗凝治疗未达标的预测效力。利用起始INR值预测华法林治疗抗凝强度未达标的ROC曲线下面积(AUC)为0.872(95%CI=0.772～0.973,P<0.001)。当最佳临界值(CP)为1.145时,预测抗凝强度未达标的敏感性为82.65%,特异性为80%,阳性预测值为97.59%,阴性预测值为32%。通过起始INR值预测华法林抗凝未达标的效力良好,多数华法林治疗患者在使用2.5 mg/d后,如果起始INR值小于1.145,应考虑积极调整华法林剂量。
To evaluate critical value of warfarin initial international normalized radio(INR) for predicting stable INR using receiver operating characteristic curve.A total of 108 patients with warfarin treatment of 2.5 mg/d were enrolled as the subjects, who detected initial INR after two days and detected stable INR after 7 days, INR<2 defined as anticoagulation intensity dissatisfaction.To verify initial INR predicting stable INR using receiver operating characteristic curve.The area under the ROC curve for initial INR to predicting stable INR was 0.872(95% CI:0.772～0.973,P<0.001),when cut point was 1.145, the sensitivity was 82.65%, the specificity was 80%. Positive predictive value was 97.59%, negative predictive value was 32%. Through initial INR value prediction of warfarin anticoagulation effect was good, the majority of patients with warfarin therapy after using of 2.5 mg/d, if the initial INR value is less than 1.145, actively adjust the warfarin dose should be taken into account.
To evaluate critical value of warfarin initial international normalized radio(INR) for predicting stable INR using receiver operating characteristic curve.A total of 108 patients with warfarin treatment of 2.5 mg/d were enrolled as the subjects, who detected initial INR after two days and detected stable INR after 7 days, INR<2 defined as anticoagulation intensity dissatisfaction.To verify initial INR predicting stable INR using receiver operating characteristic curve.The area under the ROC curve for initial INR to predicting stable INR was 0.872(95% CI:0.772～0.973,P<0.001),when cut point was 1.145, the sensitivity was 82.65%, the specificity was 80%. Positive predictive value was 97.59%, negative predictive value was 32%. Through initial INR value prediction of warfarin anticoagulation effect was good, the majority of patients with warfarin therapy after using of 2.5 mg/d, if the initial INR value is less than 1.145, actively adjust the warfarin dose should be taken into account.
引文
[1] Koga T,Shibata Y,Kawamoto M.Adherence to and issues on our institutional guidelines on heparin administration after withdrawal of warfarin before elective surgery[J].Masui,2017,66(4):456-62.
[2] Abohelaika S,Wynne H,Avery P,et al.Effect of genetic and patient factors on warfarin pharmacodynamics following warfarin withdrawal:implications for patients undergoing surgery[J].Thromb Res,2018,171:167-70.
[3] National Committee for Clinical Laboratory Standards.Collection,transport,and processing of bloods pecimens for testingplasma-based coagulation assays;approved guideline-fourth edition[S].NCCLS,2H21-A 4,003.
[4] National Committee for Clinical Laboratory Stardards.One-stage prothrombintime(PT) test and activated partial thromboplastin time(APTT) test;approved guideline[S].NCCLS,H 47-A,1996.
[5] Tyson K,Hutchinson N,Williams S,et al.Identification of clinical factors predicting warfarin sensitivity after cardiac surgery[J].Ther Adv Drug Saf,2018,9(8):415-24.
[6] Weycker D,Li X,Wygant G D,et al.Effectiveness and safety of apixaban versus warfarin as outpatient treatment of venous thromboembolism in U.S.Clinical Practice[J].Thromb Haemost,2018,118(11):1951-61.
[7] De T,Alarcon C,Hernandez W,et al.Association of senetic variants with warfarin-associated bleeding among patients of african descent[J].JAMA,2018,320(16):1670-7.
[8] Holbrook A,Schulman S,Witt D M,et al.Evidence-based management of anticoagulant therapy.Antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2012,141(2 Suppl):e152S-e184S.
[9] 中华医学会心血管病学分会.华法林抗凝的中国专家共识[J].中华内科杂志,2013,52(1):76-82.
[10] Holbrook A M,Pereira J A,Labiris R,et al.Systematic overview of warfarin and its drug and food interactions[J].Arch Intern Med,2005,165(10):1095-106.
[2] Abohelaika S,Wynne H,Avery P,et al.Effect of genetic and patient factors on warfarin pharmacodynamics following warfarin withdrawal:implications for patients undergoing surgery[J].Thromb Res,2018,171:167-70.
[3] National Committee for Clinical Laboratory Standards.Collection,transport,and processing of bloods pecimens for testingplasma-based coagulation assays;approved guideline-fourth edition[S].NCCLS,2H21-A 4,003.
[4] National Committee for Clinical Laboratory Stardards.One-stage prothrombintime(PT) test and activated partial thromboplastin time(APTT) test;approved guideline[S].NCCLS,H 47-A,1996.
[5] Tyson K,Hutchinson N,Williams S,et al.Identification of clinical factors predicting warfarin sensitivity after cardiac surgery[J].Ther Adv Drug Saf,2018,9(8):415-24.
[6] Weycker D,Li X,Wygant G D,et al.Effectiveness and safety of apixaban versus warfarin as outpatient treatment of venous thromboembolism in U.S.Clinical Practice[J].Thromb Haemost,2018,118(11):1951-61.
[7] De T,Alarcon C,Hernandez W,et al.Association of senetic variants with warfarin-associated bleeding among patients of african descent[J].JAMA,2018,320(16):1670-7.
[8] Holbrook A,Schulman S,Witt D M,et al.Evidence-based management of anticoagulant therapy.Antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2012,141(2 Suppl):e152S-e184S.
[9] 中华医学会心血管病学分会.华法林抗凝的中国专家共识[J].中华内科杂志,2013,52(1):76-82.
[10] Holbrook A M,Pereira J A,Labiris R,et al.Systematic overview of warfarin and its drug and food interactions[J].Arch Intern Med,2005,165(10):1095-106.