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KMID : 0869620070240030196
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Journal of Korean Society of Hospital Pharmacists
2007 Volume.24 No. 3 p.196 ~ p.202
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Warfarin maintenance dosages in very elderly Korean patients
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Nam Ju-Yeun
Choi Kyung-Suk
Jung Young-Mi
Namgung Hyung-Wook
Lee Byung-Koo
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Abstract
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Warfarin is the most frequently prescribed oral anticoagulant in Korea. Dosage is individualized for each patient because it has the narrow therapeutic index and multiple patient variables such as age, sex, weight, drug interaction, underlying disease and nutritional status. So far, several studies have provided data on age-based warfarin dosages. However, there is no standard guideline for warfarin maintenance dosages in very elderly Korean patients. The aims of the study are to describe warfarin maintenance dosages for them and to determine difference of maintenance dosages between elderly and very elderly patients. Electronic Medical Records(EMRs) of patients enrolled in Anti-Coagulation Service(ACS) in Seoul National University Bundang Hospital(SNUBH) from 10th May, 2003 to 31st August, 2006 were reviewed. Subjects should have had a targeted INR of 2.0-3.0, and two consecutive INR values(INR1 and INR2) within the targeted range with at least 7 days apart. Patients who had factors affecting warfarin maintenance dosages were excluded. Also, patients were divided into two groups according to the age : the elderly patients(65-75 years of age) and the very elderly patients(> 75 years of age). A total of 252 patient EMRs were reviewed, and 128 patients(77 males; 51 females) met the criteria for inclusion in the study. The age(mean ± S.D.) of the elderly patients was 69.3 ± 2.6 years and that of the very elderly patients was 79.7 ± 3.9 years. Atrial fibrillation was the most common indication for warfarin use. The mean warfarin maintenance dosage was significantly lower with increasing age : the weekly dose(mean ± S.D.) of the elderly patients was 27.4 ± 6.6mg, while that of the very elderly patients was 23.4 ± 8.1mg. There was no significant difference between two groups in INR1, INR2, weight, number of medication taken, serum albumin concentration and platelet count. The very elderly patients require lower warfarin maintenance dosages than the elderly patients when there was no other factor affecting dosage but age. Further study, Standard guideline for warfarin maintenance dosages in very elderly Korean patients will be established due to increasing the number of patients.
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KEYWORD
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Warfarin, Anticoagulant, Maintenance dosage, Very elderly patients
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