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Warfarin is an anticoagulant for preventing thromboembolic disorder. Because of it´s narrow therapeutic range and adverse effect such as bleeding or thromboembolism, we should monitor patient closely. The patients must be educated various drug-drug and drug-food interaction. We investigated patient´s awareness and the rate of adverse effect for warfarin therapy. This study was conducted through retrospective chart review and questionnaire of fifty outpatients who received warfarin sodium for at least three months from July to September 1998. As s result, forty one patients(82%) have known about disease. The awareness of pharmacological effect and adverse effect was 48% and 52%, respectively. The awareness of drug-drug and drug-food interaction was 6% and 0%, respectively. Thirty two patients(64%) experienced bleeding complication. Among the patients, twenty nine patients experienced minor bleeding such as bruise, delayed hemostatis, gingival bleeding, epistaxis, hemoptysis, bloody stool. And three patients visited hospital because of GI bleeding, intracranial bleeding or severe epistaxis. Two patients(4%) experienced thromboembolic complication such as stroke or pulmonary embolism. The percentage of the patients maintained unstable and subtherapeutic International Normalized Ratio(INR) was 28% and 48%. respectively. The rate of bleeding complication of the patients maintained stable and unstable INR was 25% and 93%, respectively. In this research, we found that the patient´s awareness was low and more adverse effects occurred in the patient with unstable INR. We concluded that medical team educate patient continuously and adjust dosage regimen for Warfarin therapy. Pharmacist-managed Anticoagulation Service(ACS) may provide to improve the quality and end ensure the continuity of patient care.
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