PDF(Pubmed)
Abstract：
UNASSIGNED: The management of warfarin therapy presents clinical challenges due to its narrow therapeutic index. We aimed to evaluate the comparative effectiveness of different management strategies in patients using warfarin.
UNASSIGNED: PubMed, Embase, Cochrane CENTRAL, CINAHL, and EBSCO Open Dissertation were searched from inception to 8 May 2024. Randomized controlled trials that compared the following interventions: patient self-management (PSM), patient self-testing (PST), anticoagulation management services (AMS), and usual care in patients prescribed warfarin for any indication were included. Risk ratios (RR) with 95% confidence interval (CI) were estimated using a random-effects model. Surface under the cumulative ranking curves (SUCRA) were used to rank different interventions. The certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) online platform. This study is registered with PROSPERO (CRD42023491978).
UNASSIGNED: Twenty-eight trials involving 8100 participants were included, with follow-up periods of 1-24 months. Mean warfarin dosages were 4.9-7.2 mg/day. Only PSM showed a significant reduction of major TE risk compared with usual care (RR = 0.41; 95% CI: 0.24, 0.71; I2 = 0.0%) with moderate certainty of evidence. The 97.6% SUCRA also supported the beneficial effects of PSM over other interventions. The combined direct and indirect evidence showed significantly higher TTR in PSM compared with usual care (MD = 7.39; 95% CI: 2.39, 12.39), with very low certainty. However, direct evidence showed non-significant TTR improvement (MD = 6.49; 95% CI: -3.09, 16.07, I2 = 96.1%). No differences across various strategies were observed in all-cause mortality, major bleeding, stroke, transient ischemic attack, and hospitalization.
UNASSIGNED: PSM reduces the risk of major TE events compared with usual care, tends to improve anticoagulation control, and should be considered where appropriate.
UNASSIGNED: Agency for Healthcare Research and Quality (grant ID 5R18HS027960).
UNASSIGNED: PubMed, Embase, Cochrane CENTRAL, CINAHL, and EBSCO Open Dissertation were searched from inception to 8 May 2024. Randomized controlled trials that compared the following interventions: patient self-management (PSM), patient self-testing (PST), anticoagulation management services (AMS), and usual care in patients prescribed warfarin for any indication were included. Risk ratios (RR) with 95% confidence interval (CI) were estimated using a random-effects model. Surface under the cumulative ranking curves (SUCRA) were used to rank different interventions. The certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) online platform. This study is registered with PROSPERO (CRD42023491978).
UNASSIGNED: Twenty-eight trials involving 8100 participants were included, with follow-up periods of 1-24 months. Mean warfarin dosages were 4.9-7.2 mg/day. Only PSM showed a significant reduction of major TE risk compared with usual care (RR = 0.41; 95% CI: 0.24, 0.71; I2 = 0.0%) with moderate certainty of evidence. The 97.6% SUCRA also supported the beneficial effects of PSM over other interventions. The combined direct and indirect evidence showed significantly higher TTR in PSM compared with usual care (MD = 7.39; 95% CI: 2.39, 12.39), with very low certainty. However, direct evidence showed non-significant TTR improvement (MD = 6.49; 95% CI: -3.09, 16.07, I2 = 96.1%). No differences across various strategies were observed in all-cause mortality, major bleeding, stroke, transient ischemic attack, and hospitalization.
UNASSIGNED: PSM reduces the risk of major TE events compared with usual care, tends to improve anticoagulation control, and should be considered where appropriate.
UNASSIGNED: Agency for Healthcare Research and Quality (grant ID 5R18HS027960).
摘要：
■由于其狭窄的治疗指数，华法林治疗的管理提出了临床挑战。我们旨在评估不同管理策略在使用华法林患者中的比较效果。
■PubMed,Embase,科克伦中部,CINAHL,和EBSCO公开论文从开始到2024年5月8日进行了检索。比较以下干预措施的随机对照试验：患者自我管理（PSM），患者自我测试（PST），抗凝管理服务（AMS），和常规治疗的患者处方华法林的任何适应症都包括在内。使用随机效应模型估计具有95%置信区间(CI)的风险比(RR)。使用累积排名曲线下的表面（SUCRA）对不同的干预措施进行排名。使用网络Meta分析（CINeMA）在线平台评估证据的确定性。本研究在PROSPERO(CRD42023491978)注册。
■纳入了涉及8100名参与者的28项试验，随访1-24个月。平均华法林剂量为4.9-7.2mg/天。与常规治疗相比，仅PSM显示主要TE风险显着降低（RR=0.41；95％CI：0.24，0.71；I2=0.0％），证据确定性适中。97.6%的SUCRA也支持PSM对其他干预措施的有益影响。联合的直接和间接证据显示，与常规治疗相比，PSM的TTR明显更高（MD=7.39；95％CI：2.39，12.39），确定性很低。然而,直接证据显示TTR无显著改善(MD=6.49;95%CI:-3.09,16.07,I2=96.1%).各种策略在全因死亡率方面没有观察到差异，大出血,中风,短暂性脑缺血发作,和住院。
■与常规护理相比，PSM降低了重大TE事件的风险，倾向于改善抗凝控制，并应在适当的情况下加以考虑。
■医疗保健研究和质量机构（批准ID5R18HS027960）。
■PubMed,Embase,科克伦中部,CINAHL,和EBSCO公开论文从开始到2024年5月8日进行了检索。比较以下干预措施的随机对照试验：患者自我管理（PSM），患者自我测试（PST），抗凝管理服务（AMS），和常规治疗的患者处方华法林的任何适应症都包括在内。使用随机效应模型估计具有95%置信区间(CI)的风险比(RR)。使用累积排名曲线下的表面（SUCRA）对不同的干预措施进行排名。使用网络Meta分析（CINeMA）在线平台评估证据的确定性。本研究在PROSPERO(CRD42023491978)注册。
■纳入了涉及8100名参与者的28项试验，随访1-24个月。平均华法林剂量为4.9-7.2mg/天。与常规治疗相比，仅PSM显示主要TE风险显着降低（RR=0.41；95％CI：0.24，0.71；I2=0.0％），证据确定性适中。97.6%的SUCRA也支持PSM对其他干预措施的有益影响。联合的直接和间接证据显示，与常规治疗相比，PSM的TTR明显更高（MD=7.39；95％CI：2.39，12.39），确定性很低。然而,直接证据显示TTR无显著改善(MD=6.49;95%CI:-3.09,16.07,I2=96.1%).各种策略在全因死亡率方面没有观察到差异，大出血,中风,短暂性脑缺血发作,和住院。
■与常规护理相比，PSM降低了重大TE事件的风险，倾向于改善抗凝控制，并应在适当的情况下加以考虑。
■医疗保健研究和质量机构（批准ID5R18HS027960）。
