뇌졸중 환자군의 Warfarin Nomogram 설정을 위한 실제 처방전 평가 (Evaluation of Prescription Data for Development of Warfarin Nomogram in Korean Patients with Cerebral Infarction)

서지정보

· 발행기관 : 대한약학회
· 수록지 정보 : 약 학 회 지 / 53권 / 2호 / 83 ~ 88페이지
· 저자명 : 장주영, 임성실, 고경미, 윤지연, 한옥연, 임성실

초록

Warfarin is the most widely used oral anticoagulant in the world but maintenance of proper therapeutic range and prevention of adverse drug events always need to be careful. Especially, in Korea, warfarin dosing for patients with cerebral infarction is currently based on the nomogram which is done by foreign clinical trials not for the Korean. Therefore we evaluate warfarin dose of patients in the neurology and eventually get the base data of warfarin nomogram for Korean with stroke. We performed this study retrospectively on reviewing the medical charts to evaluate the prescribed loading dose (LD) and maintenance dose (MD) of warfarin and each responding International Normalized Ratio (INR) with any bleeding adverse drug reaction including of patient's characteristics for total 75 patients with stroke in the department of neurology of Kangnam ST. Mary’s Hospital from January 2005 to June 2008. All evaluated patients should not be treated with warfarin in the past at all and should be initiated warfarin therapy first.ly at this time. All evaluated patients were divided as two classes by wafarin LD which is; 1) HDG - a high loading dosing group prescribed over 5mg, and 2) LDG - a low loading dosing group prescribed 5mg or below. As a result, average LD was 9.34±0.22 mg (p=0.000) in HDG and 4.25±0.39 mg (p=0.000) in LDG. Average baseline INR was 0.91±0.05 (p=0.161) in HDG and 1.26±0.14 (p=0.002) in LDG. On the first and second week, daily MD was 4.21±0.14 mg (p=0.000) and 2.96±0.19 mg (p=0.696) in HDG and also in LDG, 2.95±0.29 mg (p=0.000) and 3.14±0.36 mg (p=0.696). Also average reacting daily INR was respectively 2.53±0.12 (p=0.141) and 2.51±0.16 (p=0.678) in HDG, and in LDG, 2.11±0.17 (p=0.141) and 2.42±0.14 (p=0.678). After the second week, INR was not measured in regularly. Also most of underlying diseases were hypertension (n=38), diabetes mellitus (n=14), dyslipidemia (n=8) in order. Four ADRs with simple hemorrhage were occurred and those were due to drug interaction by comedication.
In the conclusion, proper starting LD for Korean with stroke is 10 mg if baseline INR is around 1.0 or 5 mg if over 1.3. Proper MD need to be more evaluated in the future for setting up warfarin nomogram to make prospective study.

영어초록

Warfarin is the most widely used oral anticoagulant in the world but maintenance of proper therapeutic range and prevention of adverse drug events always need to be careful. Especially, in Korea, warfarin dosing for patients with cerebral infarction is currently based on the nomogram which is done by foreign clinical trials not for the Korean. Therefore we evaluate warfarin dose of patients in the neurology and eventually get the base data of warfarin nomogram for Korean with stroke. We performed this study retrospectively on reviewing the medical charts to evaluate the prescribed loading dose (LD) and maintenance dose (MD) of warfarin and each responding International Normalized Ratio (INR) with any bleeding adverse drug reaction including of patient's characteristics for total 75 patients with stroke in the department of neurology of Kangnam ST. Mary’s Hospital from January 2005 to June 2008. All evaluated patients should not be treated with warfarin in the past at all and should be initiated warfarin therapy first.ly at this time. All evaluated patients were divided as two classes by wafarin LD which is; 1) HDG - a high loading dosing group prescribed over 5mg, and 2) LDG - a low loading dosing group prescribed 5mg or below. As a result, average LD was 9.34±0.22 mg (p=0.000) in HDG and 4.25±0.39 mg (p=0.000) in LDG. Average baseline INR was 0.91±0.05 (p=0.161) in HDG and 1.26±0.14 (p=0.002) in LDG. On the first and second week, daily MD was 4.21±0.14 mg (p=0.000) and 2.96±0.19 mg (p=0.696) in HDG and also in LDG, 2.95±0.29 mg (p=0.000) and 3.14±0.36 mg (p=0.696). Also average reacting daily INR was respectively 2.53±0.12 (p=0.141) and 2.51±0.16 (p=0.678) in HDG, and in LDG, 2.11±0.17 (p=0.141) and 2.42±0.14 (p=0.678). After the second week, INR was not measured in regularly. Also most of underlying diseases were hypertension (n=38), diabetes mellitus (n=14), dyslipidemia (n=8) in order. Four ADRs with simple hemorrhage were occurred and those were due to drug interaction by comedication.
In the conclusion, proper starting LD for Korean with stroke is 10 mg if baseline INR is around 1.0 or 5 mg if over 1.3. Proper MD need to be more evaluated in the future for setting up warfarin nomogram to make prospective study.

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