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KMID : 0869620120290020175
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Journal of Korean Society of Hospital Pharmacists
2012 Volume.29 No. 2 p.175 ~ p.181
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Warfarin Maintenance Dosing patterns in patients undergoing RFA for atrial fibrillation
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Sung Mi-Young
Ko Kyung-Mi
An Sung-Sim
Kim Soon-Joo
La Hyen-O
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Abstract
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Radiofrequency ablation (RFA) is an effective strategy for the treatment of drugrefractory
atrial fibrillation (AF). Our department evaluated warfarin maintenance dose on peri
procedure in patients with AF, who underwent RFA, and analyzed factors that affected
International normalized ratio (INR) to obtained factors, which are applicable in ACS (anticoagulant service).
A total of 84 patients were enrolled, who underwent the RFA and were followed up at cardiological outpatient department from January 2009 to June 2010. Of those 84 patients, only 37 patients maintained target INR* in survey period. They were treated with warfarin during ablation and visited at ACS regularly. This study is based on ACS counsel record and EMR, retrospectively.
Investigated characteristics are age, gender, smoking, drinking, the number of RFA,
comorbidities, and the mean total weekly dose (TWD), during the period of attained target INR and mean value of INR in pre- and post-ablation.
The mean TWD of the 37 patients were 28.1 mg (±0.98) pre-ablation and 24.9mg(±0.83) postablation, which decreased 12.0% compared to that of pre-ablation (p<0.001). Factors like age, gender, hypertension, and early adverse effect, didn`t affect the degree of warfarin dose reduc-tion between pre- and post RFA. However, TWD differed significantly, according to the maintenance dosage change on peri-procedure between the diabetic group and the non-diabetic group (p=0.05). TWD of non-diabetics decreased during the procedure (28.5±1.07→24.8±0.91, p<0.001), and TWD of diabetics did not differ significantly, during the procedure (p=1.0).
Based on this study, it’s possible for patients after RFA to be treated with lower dose warfarin.
But further clinical trials are needed to customize the degree of warfarin dose reduction.
Diabetics can maintain the same dosage of warfarin compared with beforehand, but it needs confirmed results through large study.
Target INR*: 2.0~3.0(±0.2)
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KEYWORD
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RFA, TWD(total weekly dose), INR, risk factor
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