社團法人臺灣臨床藥學會

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【原著】Warfarin 在亞洲族群之治療目標準則
Warfarin Dosing Algorithm: Specific INR Goal for Asian Population
Warfarin、國際標準化凝血酶原時間比值 (INR)、劑量、亞洲族群、Warfarin, INR, Dosing, Asian *Corresponding
林欣儀Shin-Yi Lin1 、陳以雯Yi-Wen Chen1 、康皓程Hao-Cheng Kang1 、吳宜真Yee-Jen Wu1 、朱蓁蓁Chen-Chen Chu1 、林慧玲Fe-Lin Lin Wu1.3 、沈麗娟Li-Jiuan Shen1.3 、黃織芬Chih-Fen Huang*1.3
1國立臺灣大學醫學院附設醫院藥劑部 、2國立臺灣大學醫學院臨床藥學研究所 、3國立臺灣大學藥學專業學院
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。
 
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.
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