심방세동 환자의 연령별 와파린 초기용량 적정성 평가 및 새로운 용량조절 기준설정
Studies on the Appropriateness of Age-related Warfarin Initial Dosage Guideline and Proposal of New Dosage Protocol in Atrial Fibrillation
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Abstract
There are limited data on the initial dose of warfarin therapy in outpatients. The Anti-coagulation Service(ACS) of the Samsung Medical Center(SMC) confirmed that patient age is the most important determinant of warfarin requirement in Korean, and has set up age-related warfarin initial dosage guideline: warfarin 3.5 mg/day for under 50-year-old, 3 mg/day for age between 51~60, 2.5 mg/day for age between 61~70, 2 mg/day for over 71-year-old patients, followed by checking INR weekly. In the context, the purpose of this study is to analyze the appropriateness of age-related warfarin initial dosage guideline and propose a new dosage protocol. Study was processed as follows. First, targeted patients who initiated warfarin therapy with age-related warfarin initial dosage guideline(target INR 2.0-3.0) in ACS of our out-patient medical center and had indication of atrial fibrillation were investigated. For the study, 81 patients' records were analysed retrospectively. Before age-related warfarin initial dosage guideline was applied, the average period of achieving therapeutic levels was 32.42 days, on the other hands, 18.07 days for age-related warfarin initial dosage guideline. No patient suffered any thrombotic or hemorrhagic complications during taking age-related warfarin initial dose. The age-related initial warfarin dosage guideline has proposed safe and effective in out-patient warfarinization. But the group of age between 61~70, it took 5 days longer than other group, and needs increase in initial warfarin dose. The INR checked within 1 week and the ratio of the warfarin dose of maintaining therapeutic level to initial dose was analysed. The less INR checked within 1 week, need the more warfarin dose to maintain therapeutic level(p<0.0001). All things considered, this study allowed new protocol for warfarin dose regulation like followings; 100% increase of initial warfarin dose for checked INR under 1.2, 50% increase for INR 1.2~1.4, 30% increase for INR 1.4~1.6, 10~20% increase for INR 1.6~1.8, 10% increase for INR 1.8~1.9, maintain initial dose for INR 1.9~2.0, decrease 10% for INR over 2.0. The study was designed to the appropriateness of age-related warfarin initial dosage guideline. The guideline was shortened required period of achieving therapeutic levels. And based on the results, this study proposed a new dosage protocol.
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