Follow-Up of a Home Care Patient: Warfarin Usage

Year 2016, Volume: 30 Issue: 2, 89 - 94, 21.10.2016

Muhteber Çolak Özden Gökdemir Ülkü Bulut Mehtep Kartal

Abstract

Warfarin is
commonly used drug; however its dosage is affected
by plenty of food and drugs. As it can cause bleeding, its follow-up is important. Patients are monitored by International Normalized Ratio (INR), standard value of the prothrombin
time, and the target values vary 2-3.5 for
different diagnosis.

A 76-year-old female patient had a cerebrovascular accident after a cholecystectomy operation. As a sequel she had loss of strength in her right foot. Her caregivers, 77-year-old husband and a professional caregiver, applied to home care services (HCSs).

Ecchymosis was seen in her body in her physical examination while vital signs were normal. Additionally decubitus ulcers on her gluteal
region, loss of strength at her right foot was determined. She had been in this
condition for 5-6 months and the ecchymosis was attributed to impacts during caring. She was referred
to emergency department because of bleeding
risk. In her first evaluation INR: 6.6, however no bleeding
was not detected except for widespread ecchymosis. Warfarin was stopped
for 3 days and the treatment regimen was planned
again. After 12 days, control INR: 2.96. Family
physicians' informing caregivers during
follow-up of
 home-care  patients,  about
 patients'  drugs,  drug-drug
 interactions,  especially drug-food
interactions regularly
is important.

Keywords

home care, warfarin, INR

Evde bakım hastasının izlemi: Varfarin kullanımı

Abstract

Varfarin sık kullanılan ancak kullanım dozu pek çok ilaç ve yiyeceklerde etkilenen bir ilaçtır. Kanamaya neden olabileceğinden izlemi önemlidir. Hastalar Protrombin Zamanı
standart değeri olan INR (International Normalized Ratio) ile izlenmekte ve
farklı tanılarda hedef değerler
2-3,5 arasında değişmektedir.

76 yaşındaki kadın hasta kolesistektomi operasyonu sonrası serebrovasküler olay geçirmiştir. Hastanın sekel olarak sağ ayağında
kuvvet kaybı mevcuttur. Hastaya bakan 77 yaşındaki eşi ve profesyonel bakıcısı evde sağlık hizmetleri (ESH) birimine başvurmuştur.

Vital bulguları normal olan hastanın vücudunda ekimozlar görüldü. Ayrıca gluteal bölgesinde bası yaraları, sağ ayakta kuvvet kaybı belirlendi. Hasta 5-6 aydır bu durumda ve morlukları bakım sırasındaki çarpmalara
bağlanmış. Kanama riski nedeniyle acil servise
sevk edildi. İlk değerlendirmesinde INR: 6,6 olup yaygın
ekimoz dışında kanama tespit edilmedi. Varfarin üç gün kesildi
ve tedavi rejimi yeniden
düzenlendi. Oniki gün
sonra bakılan kontrol INR: 2,96’ydi.

Aile hekimlerinin evde bakım hastalarının izlemlerinde bakımverenleri hastaların ilaçları, ilaç-ilaç etkileşimleri, özellikle ilaç-gıda etkileşimi konularında düzenli bilgilendirmesi önemlidir.

Keywords

evde bakım, varfarin, INR

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