Warfarin Therapy를 받는 환자에서 잠재적 약물상호작용 분석
Analysis of Potential Drug Drug Interaction with Warfarin Therapy in Hospitalized Patients
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This study investigated potential drug-drug interactions (pDDIs) with warfarin with the aim of minimizing them, and to assess the acceptability of pharmaceutical interventions by the medical team and their impact on the international normalized ratio (INR). The retrospective, observational study involved hospitalized patients (n=142) maintained on warfarin therapy with pDDI in Seoul National University Hospital from January 2012 to June 2012. Patients’demographics, medical history and medications used with daily warfarin doses were collected from electronic medical records. The pDDIs with warfarin were identified using the 9th ACCP guideline. Patients with pDDIs required lower warfarin doses than others (3.2±1.3 mg vs. 4.0±1.2 mg, p<0.05). There was a decreasing tendency for INR value in patients with pDDIs. The most common pDDIs with warfarin that resulted in increased anticoagulation were cardiovascular agents (71.8%), analgesics (16.4%), and central nervous system drugs (6.3%). Concomitant cardiovascular and analgesic drugs reduced warfarin dose requirements, compared to patients not receiving either agent (2.5±0.8 mg vs. 4.0±1.2 mg, p<0.05). The difference of INR value was 0.36 between patients treated with cardiovascular drugs and the control group. The eight patients who received pDDIs experienced bleeding complications, and displayed a higher bleeding rate than the control group (5.6% vs. 3.0%). Major and moderate pDDIs with warfarin are very common in hospitalized patients and are associated with INR level outside the therapeutic range. We conclude that concurrent use of pDDIs with warfarin is associated with increased risk of bleeding complication. Pharmaceutical interventions concerning the management of interactions by providing information to physicians can improve patient safety.
Abstract
This study investigated potential drug-drug interactions (pDDIs) with warfarin with the aim of minimizing them, and to assess the acceptability of pharmaceutical interventions by the medical team and their impact on the international normalized ratio (INR). The retrospective, observational study involved hospitalized patients (n=142) maintained on warfarin therapy with pDDI in Seoul National University Hospital from January 2012 to June 2012. Patients’demographics, medical history and medications used with daily warfarin doses were collected from electronic medical records. The pDDIs with warfarin were identified using the 9th ACCP guideline. Patients with pDDIs required lower warfarin doses than others (3.2±1.3 mg vs. 4.0±1.2 mg, p<0.05). There was a decreasing tendency for INR value in patients with pDDIs. The most common pDDIs with warfarin that resulted in increased anticoagulation were cardiovascular agents (71.8%), analgesics (16.4%), and central nervous system drugs (6.3%). Concomitant cardiovascular and analgesic drugs reduced warfarin dose requirements, compared to patients not receiving either agent (2.5±0.8 mg vs. 4.0±1.2 mg, p<0.05). The difference of INR value was 0.36 between patients treated with cardiovascular drugs and the control group. The eight patients who received pDDIs experienced bleeding complications, and displayed a higher bleeding rate than the control group (5.6% vs. 3.0%). Major and moderate pDDIs with warfarin are very common in hospitalized patients and are associated with INR level outside the therapeutic range. We conclude that concurrent use of pDDIs with warfarin is associated with increased risk of bleeding complication. Pharmaceutical interventions concerning the management of interactions by providing information to physicians can improve patient safety.
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