인공심장판막치환환자의 응급센터 내원시 warfarin에 의한 합병증에 관한 연구 (Analysis of Warfarin-induced Complications in Patients with Mechanical Heart Valve Replacement and History of Admission to Emergency Room)

서지정보

· 발행기관 : 한국임상약학회
· 수록지 정보 : 한국임상약학회지 / 17권 / 2호 / 70 ~ 75페이지
· 저자명 : 송효숙, 장병철, 곽혜선

초록

Purpose: This study was to evaluate the factors on bleeding complications and thromboembolism in patients on warfarin with mechanical heart valves visiting emergency center. Methods: Among 560 patients who were operated at Y Cardiovascular Hospital between November 2001 and October 2006, we reviewed the records of 83 patients who had mechanical heart valve and visited emergency center. Results: There were 6 major thromboembolic events, 18 major bleeding events and 25 minor bleeding events from 83 patients who visited emergency center. The mean international normalized ratio (INR) was 4.30±13.29 in patients visiting emergency center, 6.07±3.86 in patients with major bleeding, and 5.89±2.80 in patients with minor bleeding complication. There was statistically significant difference in INR between bleeding complication groups and no bleeding groups (p = 0.001 in patients with major bleeding, p<0.0001 in patients with minor bleeding). However, there was no difference in time in therapeutic range (TTR) when the therapeutic target range of INR was 1.8~3.0 (p = 0.730). With risk analysis, serum albumin level was significantly low and weekly warfarin dose was significantly high in patients with bleeding complication (p≤0.05). Conclusions: There were differences in the values of INR, albumin and weekly warfarin dose among major bleeding, minor bleeding and no complication groups even though TTR was not significantly different among the groups. To reduce anticoagulation related complications, close monitoring and systemic anticoagulation education should be offered by experienced and knowledgeable pharmacists.

영어초록

Purpose: This study was to evaluate the factors on bleeding complications and thromboembolism in patients on warfarin with mechanical heart valves visiting emergency center. Methods: Among 560 patients who were operated at Y Cardiovascular Hospital between November 2001 and October 2006, we reviewed the records of 83 patients who had mechanical heart valve and visited emergency center. Results: There were 6 major thromboembolic events, 18 major bleeding events and 25 minor bleeding events from 83
patients who visited emergency center. The mean international normalized ratio (INR) was 4.30±13.29 in patients visiting emergency center, 6.07±3.86 in patients with major bleeding, and 5.89±2.80 in patients with minor bleeding complication. There was statistically significant difference in INR between bleeding complication groups and no bleeding groups (p = 0.001 in patients with major bleeding, p<0.0001 in patients with minor bleeding). However, there was no difference in time in therapeutic range (TTR) when the therapeutic target range of INR was 1.8~3.0 (p = 0.730). With risk analysis, serum albumin level was significantly low and weekly warfarin dose was significantly high in patients with bleeding complication (p≤0.05). Conclusions: There were differences in the values of INR, albumin and weekly warfarin dose among major bleeding, minor bleeding and no complication groups even though TTR was not significantly different among the groups. To reduce anticoagulation related complications, close monitoring and systemic anticoagulation education should be offered by experienced and knowledgeable pharmacists.

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