신경과 외래 환자에서 와파린 약물요법의 후향적 평가
Retrospective Quality Assessment of Warfarin Therapy in Neurology Outpatients
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Background : The objective of this study was to prepare the anticoagulation service for outpatients in neurology with retrospective assessment of warfarin therapy. Methods : A retrospective review was completed for outpatients in neurology at Ajou University Hospital from September, 2010 to March, 2011. Patients with INR during 6 month were included. It was assessed for the ratio of the time in the therapeutic range(TTR) of INR and the frequency of extreme INR. The thromboembolic and hemorrhagic events were evaluated for the quality of warfarin therapy. The number of concomitant interacting drugs was also evaluated. Results : A total of 361 patients with 813 INR values were analyzed. The mean age was 64.7±13.7 years. The average of INR values was 2.20±0.99 and the average of total weekly dose(TWD) was 26.2±11.3mg/week. Total number of concomitant interacting drugs were 75and the mean was 2 drugs per patient. Antiplatelets were prescribed with a high frequency. The INR within therapeutic range was 392 cases (49%), subtherapeutic range, 322 cases (39%)and overtherapeutic range, 99 cases (12%). The ratio of TTR was 0.57. Extreme INR values (<1.5, ≥5.0) were observed in 197 cases (24%). Thromboembolism and bleeding events were occurred in 16 cases, respectively. Conclusion : The patients on warfarin therapy in neurology were elderly patients with high possibility of drug interaction due to polypharmacy. The ratio of subtherapeutic range was relatively high and concomitant interacting drugs were prescribed frequently. Pharmacist participation in anticoagulation service is expected to improve effectiveness and safety of warfarin therapy in neurology patients.
Abstract
Background : The objective of this study was to prepare the anticoagulation service for outpatients in neurology with retrospective assessment of warfarin therapy. Methods : A retrospective review was completed for outpatients in neurology at Ajou University Hospital from September, 2010 to March, 2011. Patients with INR during 6 month were included. It was assessed for the ratio of the time in the therapeutic range(TTR) of INR and the frequency of extreme INR. The thromboembolic and hemorrhagic events were evaluated for the quality of warfarin therapy. The number of concomitant interacting drugs was also evaluated. Results : A total of 361 patients with 813 INR values were analyzed. The mean age was 64.7±13.7 years. The average of INR values was 2.20±0.99 and the average of total weekly dose(TWD) was 26.2±11.3mg/week. Total number of concomitant interacting drugs were 75and the mean was 2 drugs per patient. Antiplatelets were prescribed with a high frequency. The INR within therapeutic range was 392 cases (49%), subtherapeutic range, 322 cases (39%)and overtherapeutic range, 99 cases (12%). The ratio of TTR was 0.57. Extreme INR values (<1.5, ≥5.0) were observed in 197 cases (24%). Thromboembolism and bleeding events were occurred in 16 cases, respectively. Conclusion : The patients on warfarin therapy in neurology were elderly patients with high possibility of drug interaction due to polypharmacy. The ratio of subtherapeutic range was relatively high and concomitant interacting drugs were prescribed frequently. Pharmacist participation in anticoagulation service is expected to improve effectiveness and safety of warfarin therapy in neurology patients.
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