항응고 약물상담 환자를 대상으로 한 Warfarin의 약물상호작용 사례분석

Abstract

Warfarin, one of the typical drugs causing drug interactions, could give rise to a fluctuation in its anti-coagulating effect. The aim of this study is to suggest the means of increasing the application effect and decreasing the fluctuation in its anti-coagulating effect of warfarin by analyzing the cases of drug interactions of warfarin applied to ACS patients. The samples are cases of ACS patients in Fatima Hospital from March 2001 when ACS was first introduced to September 2009 collected through ACS consultation records and OCS program. Over the period, the number of ACS patients in Fatima Hospital were 219 in total. Among them, 32 persons have experienced drug interactions and the total cases used for final analysis were 38. Results of the analysis revealed that drug interactions occurred mainly in the age group of over 50, more than 70% of total drug interactions occurred in the group of patients with less than 3 years of application period. And the processes of taking drugs that induced drug interactions were diverse, 17 cases(44.7%) were attributable to the prescriptions of other departments within Fatima Hospital, 16 cases(42.1%) were from the other hospitals and 5 cases(13.2%) were due to patient's direct purchase from drug stores. Investigating the time of detection, 34 cases(89.5%) were detected at the first ACS after taking the inducing drugs and 4 cases(10.5%) were observed after the first ACS which implies that detailed monitoring on drug application is necessary. Total number of drugs causing drug interactions amounts 31 kinds. Of them, cimetidine, aceclofenac, celecoxib, chondroitin and glucosamine drugs for stomach, pain, and arthritis revealed high frequency. In addition, allopurinol, doxifluridine, fluconazole, isoniazid and levothyroxine drugs prerequisite for the treatment of diseases also turned out engaged in inducing drug interactions albeit low in frequency. So cautious international normalized ratio(INR) monitoring seems inevitable for the adjustment of proper doses of warfarin. Increase and decrease of INR caused by drug interactions turned out 35 and 3 cases, respectively. And 9 cases of adverse effects such as broad ranges of bruise, red spot, swelling, gingival bleeding, bloody stool were observed. From the above mentioned, it seems desirable to furnish informations on drugs that can cause fluctuation in anti-coagulating effect to both internal and as well as external medical teams. At the same time, cautious monitoring and education regarding the drugs prescribed for the ACS patients seems necessary. Furthermore, when patients are required to take specified drug, careful attention has to be taken to maintain proper INR by adjusting warfarin dose.