Capecitabine 병용시 Warfarin 용량 조절 기준 설정
Proposal for Warfarin Dosage Guideline during Capecitabine Therapy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Several studies have recommended the reduction of warfarin dosage when capecitabine has been added, however, no one has suggested appropriate guidelines. Based on the data, we tried to determine the clinically available warfarin dosage guidelines after this drug combination. A retrospective analysis was done for all patients with capecitabine seen by the anticoagulation service(ACS) at Samsung Medical Center from February 1, 2000 to October 30, 2009. Patients who had stable INR values on warfarin for at least 1 month and who had not received drugs known to alter INR values or interact with warfarin. A total of eight patients met the inclusion criteria. During the first 3 cycle of capecitabine therapy, the requirement for warfarin dose was associated with duration of treatment with capecitabine. Continuous dose reduction is needed every cycles of capecitabine therapy to maintain the INR in therapeutic range. Although no major bleeding was observed in the study group, minor bleeding occurred in 3 patients. We recommend close monitoring of INR on day 0, day 10 of every cycles for a period of 21 days, with an appropriate adjustment of warfarin dose. The reductions of warfarin dose necessary for maintaining therapeutic INR is: 0-20% for 1 cycle, 20-40% for 2 cycle, 40-60% for 3 cycle. This study provide clinically available dosage guidelines after taking concomitant capecitabine and warfarin.
Abstract
Several studies have recommended the reduction of warfarin dosage when capecitabine has been added, however, no one has suggested appropriate guidelines. Based on the data, we tried to determine the clinically available warfarin dosage guidelines after this drug combination. A retrospective analysis was done for all patients with capecitabine seen by the anticoagulation service(ACS) at Samsung Medical Center from February 1, 2000 to October 30, 2009. Patients who had stable INR values on warfarin for at least 1 month and who had not received drugs known to alter INR values or interact with warfarin. A total of eight patients met the inclusion criteria. During the first 3 cycle of capecitabine therapy, the requirement for warfarin dose was associated with duration of treatment with capecitabine. Continuous dose reduction is needed every cycles of capecitabine therapy to maintain the INR in therapeutic range. Although no major bleeding was observed in the study group, minor bleeding occurred in 3 patients. We recommend close monitoring of INR on day 0, day 10 of every cycles for a period of 21 days, with an appropriate adjustment of warfarin dose. The reductions of warfarin dose necessary for maintaining therapeutic INR is: 0-20% for 1 cycle, 20-40% for 2 cycle, 40-60% for 3 cycle. This study provide clinically available dosage guidelines after taking concomitant capecitabine and warfarin.
참고문헌 (21)
- Hirsh J, "Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range", Chest, 119(1 suppl), pp.8~21 (2001)
- Ansell J, "Managing oral anticoagulant therapy", Chest, 119(1 suppl), pp.22~38 (2000)
- Harder S, "Clinically important drug interactions with anticoagulants. An updat", Clin Pharmacokinet, 30(6), pp.416~444 (1996)
- Wells PS, "Interactions of warfarin with drugs and food", Ann Intern Med, 121(9), pp.676~683 (1999)
- Shah HR, "A retrospective study of coagulation abnormalities in patients receiving concomitant capecitabine and warfarin", Clin colorectal cancer, 5(5), pp.354~358 (2006)
- Prandoni P, "Deep vein thrombosis and the incidence of subsequent symptomatic cancer", N Engl J Med, 327, pp.1128~1133 (1992)
- Luzzatto G, "The prethrombotic state in cancer", Semin Oncol, 17, pp.147~159 (1990)
- Sorensen HT, "Prognosis of cancer associated with venous thromboembolism", New Engl J Med, 343, pp.1846~1850 (2000)
- Hutten BA, "The incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio", J Clin Oncol, 18, pp.3078~3083 (2000)
- Prandoni P, "Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and thrombosis", Blood, 100(10), pp.3484~3438 (2002)
- Bona RD, "Warfarin is safe as secondary prophylaxis in patients with cancer and a previous episode of venous thrombosis", Am J Clin Oncol, 23, pp.71~73 (2000)
- Krauth D, "Safety and efficacy of longterm oral anticoagulation in cancer patients", Cancer, 59, pp.983~985 (1987)
- Xeloda, "Basel" (2001), Roche Pharmaceuticals
- Camidge R, "Significant effect of capecitabine on the pharmacokinetics and pharmacodynamics of warfarin in patient with cancer", J Clin Oncol, 23(21), pp.4719~4725 (2005)
- Janney LM, "Capecitabinewarfarin interaction", Ann Pharmacother, 39, pp.1546~1551 (2005)
- Copur MS, "An adversed interaction between warfarin and capecitabine: a case report and review of the literature", Clin Colorectal Cancer, 1(3), pp.182~184 (2001)
- Almog S, "Mechanism of warfarin potentiation by amiodarone: dose-and concentrationdependent inhibition of warfarin elimination", Eur J Clin Pharmacol, 28(3), pp.257~261 (1985)
- Fang MC, "Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation", Ann Intern Med, 141(10), pp.745~752 (2004)
- Brigden ML, "Audit of the frequency and clinical response to excessive oral anticoagulation in an out-patient population", Am J Hematol, 59(1), pp.22~27 (1998)
- Lousberg TR, "Evaluation of excessive anticoagulation in a group model health maintenance organization", Arch Intern Med,, 158(5), pp.528~534 (1998)