경구용 항응고제를 복용하는 뇌경색 환자에서 프로스롬빈 타임에 영향을 주는 요인
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Background & Objectives: Adequate maintenance of INR value is important in the secondary prevention of stroke in patients receiving warfarin. Although there are many factors that affect the INR value, these factors have rarely been systematically studied in this country where the concept of evidence-based medicine is not strong. The purpose of the present study was to elucidate factors affecting the INR value in stroke patients receiving warfarin. Method: Between March and October 2003, we studied consecutive stroke patients receiving anticoagulation at the Neurology Outpatient Clinic of the Asan Medical Center who had revealed adequate PT (1.7-3.0 INR) at the time of the previous visit. With the use of a standardized protocol, we assessed patients’demographic characteristics, the compliance to medication, the amount of alcohol and cigarette smoking, the experience of alternative therapy (acupuncture, Bu-Hwang, moxa cautery, etc), the amount of stress, intake of specific food product (green tea, ginseng, garlic, etc), and the intake of newly prescribed drugs including herbal medication. Results: Total subjects were 138 patients. The patients’ measured INR value was adequate in 77 patients (mean, 2.24±0.35, A.G.), low in 43 patients (mean, 1.42 ±0.35, L.G.), and high in 18 patients (mean, 3.84±1.37, H.G.). The three groups were compared with each other with ANOVA or Chi squares. Gender, economic status, the follow-up duration after the onset of stroke, and the interval of PT test were not different among the three groups while age (p<0.01) and the education level (p<0.05) were different. Factors that were different between A.G. and L.G. included irregular medication (p<0.01), the intake of specific food products such as green liquor, a lot of lettuce, pine needles (p<0.01), recent increase in alcohol intake (p<0.05), recent intake of herbal medicine (p<0.01) and recently having stress (p<0.05). The recent intake of herbal medicine (p<0.01) and having high stress (p<0.01) was also different between A.G. and H.G. Conclusion: INR value isinfluenced by irregular medication, recent stress, recently in creased intake of alcohol, recent intake of specific food products and herbal medication. Therefore, these possibilities should be considered when there is an alteration of the patient’s INR value. For the adequate maintenance of INR value, an appropriate education to the patients should be made on the bases of these results.
Abstract
Background & Objectives: Adequate maintenance of INR value is important in the secondary prevention of stroke in patients receiving warfarin. Although there are many factors that affect the INR value, these factors have rarely been systematically studied in this country where the concept of evidence-based medicine is not strong. The purpose of the present study was to elucidate factors affecting the INR value in stroke patients receiving warfarin. Method: Between March and October 2003, we studied consecutive stroke patients receiving anticoagulation at the Neurology Outpatient Clinic of the Asan Medical Center who had revealed adequate PT (1.7-3.0 INR) at the time of the previous visit. With the use of a standardized protocol, we assessed patients’demographic characteristics, the compliance to medication, the amount of alcohol and cigarette smoking, the experience of alternative therapy (acupuncture, Bu-Hwang, moxa cautery, etc), the amount of stress, intake of specific food product (green tea, ginseng, garlic, etc), and the intake of newly prescribed drugs including herbal medication. Results: Total subjects were 138 patients. The patients’ measured INR value was adequate in 77 patients (mean, 2.24±0.35, A.G.), low in 43 patients (mean, 1.42 ±0.35, L.G.), and high in 18 patients (mean, 3.84±1.37, H.G.). The three groups were compared with each other with ANOVA or Chi squares. Gender, economic status, the follow-up duration after the onset of stroke, and the interval of PT test were not different among the three groups while age (p<0.01) and the education level (p<0.05) were different. Factors that were different between A.G. and L.G. included irregular medication (p<0.01), the intake of specific food products such as green liquor, a lot of lettuce, pine needles (p<0.01), recent increase in alcohol intake (p<0.05), recent intake of herbal medicine (p<0.01) and recently having stress (p<0.05). The recent intake of herbal medicine (p<0.01) and having high stress (p<0.01) was also different between A.G. and H.G. Conclusion: INR value isinfluenced by irregular medication, recent stress, recently in creased intake of alcohol, recent intake of specific food products and herbal medication. Therefore, these possibilities should be considered when there is an alteration of the patient’s INR value. For the adequate maintenance of INR value, an appropriate education to the patients should be made on the bases of these results.