Warfarin之使用評估

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Title:	Warfarin之使用評估 Drug Utilization Evaluation of Warfarin
Authors:	李建瑩 Chien-Ying Lee
Contributors:	中山醫學大學：醫學研究所;施宏哲
Keywords:	Warfarin;血栓性栓塞症;藥物使用評估 Warfarin;Thromboembolism;Drug utilization evaluation
Date:	2002
Issue Date:	2010-05-26T08:56:54Z (UTC)
Abstract:	Warfarin為常用的口服抗凝血藥物之一，可降低血栓性栓塞症的危險性。Warfarin屬於治療指數狹窄的藥物，其藥物動力學及藥物藥效學會受到相當多的因子來影響，包括藥物、日常飲食和疾病狀態等。由於Warfarin的劑量-反應相關性相當的複雜，所以它不容易安全且有效的被使用，一旦使用Warfarin不當而使INR ( International Normalized Ratio，國際標準凝血時間比)偏離正常值時，則會發生一些治療上不應有的危機，INR過高時會引起出血，INR過低則增加血栓栓塞的危險。本評估報告係針對某醫院使用Warfarin之病患，經由電腦隨機篩選出於2002年1月曾經口服Warfarin且與該院藥品有一、二級交互作用的61位患者，另外隨意抽取曾經使用Warfarin而無產生交互作用的41位患者，總共收集102個門診患者，分析及探討。並追蹤該院醫師於2002年18月使用Warfarin是否符合ASHP (American Society of Health-system Pharmacists)所訂之使用準則及相關使用規則。發現該院大部份醫師偶爾才會測PT (Prothrombin time，凝血酵素原時間)、INR，這種檢測PT值、INR值的時機，並不合乎 ACCP(American College of Chest Physicians)的規定；另外有些醫師使用Warfarin時並不符合適應症的規範，因此建議醫師務必依規定每月監測PT值、INR值，以做為調整使用Warfarin之依據；同時也建議醫師依據ACCP之抗栓塞治療會議所推薦的適應症來使用Warfarin。 Warfarin is one of the most common oral anticoagulants. Clinically, it is used to reduce the risk of thromboembolism. Warfarin has a narrow therapeutic index, as a result, its pharmacokinetic and pharmacodynamic effects may be effected by many factors, such as other medicines, foods and disease states etc. Those factors may affect its therapeutic effects. Due to its complex dose-response relationship, the safety and effectiveness in using warfarin is concerned clinically. INR(International Normalized Ratio) is one of the most important values to monitor the effect of warfarin. When INR is higher than the normal range, bleeding tendency increases, and when INR is lower than the normal range, the risk of thromboembolism increases. Inappropriate warfarin use may lead to a crisis in a treatment course. In this study, a total 102 cases from a hospital were included in the period from Jan. 2002 to Aug. 2002. 61 patients were screened out randomly by computer, who were under warfarin and other medicine therapy which lead to drug interactions with a significance rating 1 or 2, besides, 41 patients were picked up randomly who received warfarin and other medicine therapy but without any drug interaction. According to the datasheet of the cases mentioned above, retrograde reviews and analyses were monitored to discuss the accuracy of warfarin usage and to understand whether the principles and guidelines set up by the ASHP(American Society of Health-system Pharmacists) and other references were followed by the physicians or not. The results indicated that there were improper, in most of cases with proper principles and guidelines, but the monitor of PT(Prothrombin time) and INR were not adequately performed, and some cases were improper in indication. So we suggested that the indications of using warfarin set up by ACCP(American College of Chest Physicians) should be followed, and both PT and INR values of the patients with warfarin therapy should be checked monthly.
URI:	http://140.128.138.153:8080/handle/310902500/1464
Appears in Collections:	[醫學研究所] 博碩士論文

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