| Objective: Evaluation of impacts in extended care for lower limb deep vein thrombosis of discharged patients with warfarin anticoagulation treatment compliance and standards,as well as anticoagulation complications related indicators,to provide effective management approach for the long-term anticoagulation in patients with lower limbdeep vein thrombosis.Deep vein thrombosis(DVT),refers to abnormal blood clotting in deep veins,is a common clinical vascular surgical diseases.It is required continuingly to take vitamin K(VK)at least 3 months or long-term anticoagulation for those patients with lower limb DVT after discharged from hospital,where they had been treated with thrombolytic therapy,according to “2013 guidelines for deep vein thrombosis diagnosis and treatment” recommendation.However,they are subject to regular risk-benefit assessment so that the ratio of international standards(international Normalized ratio,INR)is maintained between values of 2.0-3.0.Warfarin as VK antagonists is widely used in lower limb DVT international first-line oral anticoagulation.The anticoagulation compliance is defined as patients adhere to strict followinga doctor the prescription of warfarin sodium and periodic review of the extent of compliance with international normalized ratio.Studies have shown that warfarin therapy noncompliance is widespread.A number of researches have shown that anticoagulation compliance with complications such as bleeding or thrombosis are closely related,seriously endanger the lives of patients and even result in death.This is not only a major clinical problem of long-term anticoagulant therapy,but also one of the focus of attention of vascular surgery for many years.A number of studies from national and international have confirmed : extended care can be provided to discharged patient with information,relationships and management in the continuation of three dimensions,and then conduct individualized,systematic management and guidance to be better for patient understanding of the disease and medication compliance thereby disease and recurrence and associated complications.This study was designed to implement the extended care model of DVT in patients with anticoagulant therapy process,to explore whether it is possible to improve the knowledge of anticoagulation in patients with lower limb DVT and anticoagulant treatment compliance,thereby enhance anticoagulation compliance rate,and reduce bleeding or thrombosis complications.Method:1 Study object: The object of study selected in March 2015 to May in Vascular Surgery,the Second Hospital of Hebei Medical University,of 100 DVT patients discharged from hospitalwith standard INR values that INR values are between 2.0 to 3.0,and the need to continue taking warfarin anticoagulation for at least three months after discharged.2 Study methods:the method of convenience sampling,according to odd and even numbers of 100 patients discharged date,they were divided into control and experimental group,each of 50.The two groups of patients were routinely given to education for health during hospitalization.The control group after discharged was conducted conventional mode of care,guiding patients to the local hospital or outpatient referral for drug adjustment.The discharged patients in the intervention group were not only used conventional mode,but also applied extended care intervention.An extended care team was formed,and the warfarin patient's file was established.There was one person who was responsible for telephone follow-up and dose adjustment depending on the patient needed.It was followed up seven times for good compliance of anticoagulation,and poor compliance was followed according to individualized drug adjustment programs.It was carried out for each visit according to pre-designed follow-up observation of the contents of the table.Follow-up patients were asked about retestingINR monitoring,and medication compliance.Charging physician who develops individualized drug adjustment programs,gives the patient feedback on the same day,informs the patient medication dose adjustment,and the next retesting INR value time,and provideknowledge and education of anticoagulation and related diseases.It was observed from two groups after 3 months of intervention,and found that subjects in two groups were with or without statistically significant difference occurred anticoagulation therapy compliance,and complications such as bleeding,and thrombosis presence or absence in terms of anticoagulant mastery of knowledge before and after the intervention.3 Statistical analysis: All data were analyzed using SPSS19.0 statistical software.(measurement data doing normality test,results with a median(interquartile range),namely M(QR),said group design using rank and inspection of two independent samples non parametric test of Mann-Whitney Z test method,using paired wilcoxon symbol signed-rank test;using the fourfold table chi-square test and the chi-square test R × C table for counting data;all test methods are used in two-sided test,test level ? = 0.05)Result:1 By comparison of two groups among gender,age,education level and other general information,there were no any statistically significant differences(P> 0.05).2 Before the intervention,the experimental group and the control group of patients on warfarin anticoagulation mastery of knowledge score,there were no statistically significant differences(P> 0.05).After the intervention,the experimental group mastered the anticoagulant warfarin knowledge than the control group,statistically speaking,there were nosignificant differences(P< 0.05)3 After the intervention,patients in medication compliance of the experimental group was better than the control group,and the difference was statistically significant(P<0.05).4 After the intervention,the patients in anticoagulation compliance rate in the experimental group was better than the control group,and the two groups was statistically significant(P<0.05).5After the intervention,comparison of the two groups of patients in the incidence of bleeding in the experimental group was better than the control group,andthe difference was statistically significant(P<0.05).The incidence of thrombosis outcomes,and there were not statistically significant differences(P> 0.05).Conclusion:1 Extended care model for deep venous thrombosis has improved individualized anticoagulation management in the long-term anticoagulant therapy after discharge process,and increased their awareness of anticoagulant.2 Continuation of care model to improve deep vein thrombosis patients discharged anticoagulation therapy compliance.3 Extended care model can improveanticoagulation compliance ratefor patients of lower limb DVT with long-term anticoagulation.It is more benefit for those who have higher anticoagulation compliance rate,including reduce the recurrence of the disease and improve the prognosis of patients.4 Extended care mode can be reducedbleeding adverse events in DVT patientsfor the long-term anticoagulant therapy,but there is no significant difference in the incidence of thrombosis. |
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