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KMID : 0869619980150020214
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Journal of Korean Society of Hospital Pharmacists
1998 Volume.15 No. 2 p.214 ~ p.219
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The Comparative Influence of Prophylactic Antibiotics on the Prothrombin Response to Warfarin in the Postoperative Prosthetic Cardiac Valve Patient
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Abstract
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For patients undergoing prosthetic cardiac valve replacement surgery, adequate anticoagulation is of vital importance in the prevention of thromboembolic complications. The type of prophylactic antibiotic administered to these patients during and after surgery could influence their response to subsequent warfarin anticogulation therapy. So to evaluate the response of epocelin^(®) (E) and tienam^(®) (T), we reviewed retrospectively fifty three cases of patients who undergone cardiac valve replacement surgery in Korea University Guro Hospital from January 1. 1993 to June 30. 1997. Thirty-nine of the 53 patients studied were given epocelin^(®) as the prophylactic antibiotic and fourteen of the 53 patients received tienam^(®). The prothrombin (PT) response to warfarin (W) was assessed until the third day of anticoagulant therapy. Their PTs were not significantly different at 48hrs before operation and 24hrs after operation and the morning before W was begun. The two groups received similar W doses for 2days. The PT on the morning of the third day demonstrated that T (13.9±2.1sec) was significantly greater (p<0.05) than E (11.5±1.0sec). The percentage of activity (PT%A) on the morning of the third day demonstrated that E (96.0±8.1%) was significantly greater (p<0.05) than T (78.9±16.3%). T had a significantly greater percentage of change (PT%C) in PT%A (19.5±17.3%, p<0.05) from the first to third day than E (4.1±7.4%, p<0.05). The data suggests that tienam^(®) increases warfarin sensitivity early in the postoperative course of oral anticoagulation therapy, which may lead to excessively high prothrombin times with the possibility for serious bleeding. From the result, using tienam^(®) on CVR surgery must be under drastic care and using antibiotics to prevent infection on CVR surgery needs the advice of the pharmacist in order to select safer and cheaper antibiotic which has less interaction with warfarin.
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KEYWORD
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