Warfarin在亞洲族群之治療目標準則

Warfarin Dosing Algorithm: Specific INR Goal for Asian Population

林欣儀(Shin-Yi Lin) ； 陳以雯(Yi-Wen Chen) ； 康皓程(Hao-Cheng Kang) ； 吳宜真(Yee-Jen Wu) ； 朱蓁蓁(Chen-Chen Chu) ； 林慧玲(Fe-Lin Lin Wu) ； 沈麗娟(Li-Jiuan Shen) ； 黃織芬(Chih-Fen Huang)

《臺灣臨床藥學雜誌》 23卷3期 (2015/09) Pp. 189-202

https://doi.org/10.6168/FJCP.2015.2303.04

摘要

目的：透過文獻回顧及臨床實務經驗，建立適用亞洲人族群的warfarin使用準則，以提供臨床醫師與藥師在warfarin劑量調整的依據。方法：依據文獻回顧彙整資料，經臨床專科醫師與藥師共同擬訂各適應症適當的INR治療範圍，以及依據INR檢測結果之warfarin劑量調整原則，並經過專家委員會同意後制訂。結果：制訂適用於亞洲人族群之warfarin使用準則，內容涵蓋：一、其適應症之建議INR目標與治療期間；二、起始劑量的決定；三、門診與住院病人維持劑量的調整建議；四、INR監測頻率建議；五、藥品交互作用的處置。結論：本準則可提供國人warfarin使用的治療目標及劑量調整依據，但仍須前瞻性試驗評估其適切性。

關鍵字

國際標準化凝血酶原時間比值（INR） ； 劑量 ； 亞洲族群

並列摘要

Object: Several studies showed that in Asian population, low-intensity INR reduced the risk of bleeding whereas preserved the efficacy of preventing thromboembolism. The purpose of this study is to develop an Asian-specific warfarin dosing algorithm. Methods: Previous reports concerning low-intensity INR were carefully reviewed to determine appropriate INR target for Asian population. Healthcare practitioners and clinical pharmacists with related expertise were enrolled to develop the dosing algorithm. The draft of algorithm was reviewed and approved by the Pharmacy and Therapeutic committee. Results: The Asian-specific warfarin dosing algorithm was composed of (1) therapeutic INR target and duration of treatment per indication; (2) initiation dose for warfarin; (3) guides for dose adjustment in inpatient and outpatient; (4) recommended frequency of INR monitoring; and (5) management for drug-drug interaction. Conclusions: The development of Asian-specific warfarin dosing algorithm can help increasing the efficacy and safety of warfarin utilization. Further prospective study is required to validate this algorithm.

並列關鍵字

Warfarin ； INR ； Dosing ； Asian