WARFARİN KULLANIMINA BAĞLI YÜKSEK INR DÜZEYİ İLE BAŞVURAN HASTALARIN DEĞERLENDİRİLMESİ: TANIMLAYICI BİR ÇALIŞMA

Year 2020, Volume: 10 Issue: 2, 224 - 230, 25.06.2020

Elçin Katı , İrfan Şencan , Duygu Ayhan Başer , İzzet Fidancı , İsmail Kasım , Rabia Kahveci , Adem Özkara

https://doi.org/10.16899/jcm.734137

Abstract

Amaç: Bu çalışma ile warfarin tedavisi alıp hastanemize yüksek INR değerleri ile başvuran hastaların demografik analizlerini yapmayı, mortaliteye etki eden nedenleri saptamayı ve birinci basamaktan yararlanma durumlarını belirlemeyi amaçladık.
Gereç ve Yöntem: Herhangi bir nedenle warfarin tedavisi alan, INR değeri 4'ün üzerinde olan ve komplikasyon yaşayan 187 hasta çalışmamıza dahil edildi. Hastaların hastane epikrizlerinden hastane başvuru nedeni, hangi kliniğe başvurduğu, INR değerleri, komorbid hastalık varlığı, kan transfüzyonu ihtiyacı, tedavi sonrası sağlık durumu, warfarin endikasyonu, warfarin başlayan klinik retrospektif olarak değerlendirildi. Taburculuk durumu, warfarin kullanma süresi, takip sıklığı, birinci basamağa başvuru durumu, doz değişikliklerini hangi kliniğin yaptığı, eğitim durumu telefondan öğrenildi.
Bulgular: En sık hastaneye başvuru sebepleri kanama (%22,4), dispne (%18,2), ve kusma/bulantı (%9,6) olarak belirlendi. Hastaların %34,2'sinin INR değeri 10'un üzerindeydi. En sık warfarin başlama endikasyonu AF idi. Mortaliteye etki eden prediktörler göğüs ağrısı (p:0,012) ve hematemaz (p:0,033) olarak değerlendirildi. Birinci basamağa doz değişimi için başvuran hasta oranı %12,3idi. Hastaların takipleri en sık olarak kardiyoloji, evde sağlık hizmetleri, kardiyovasküler cerrahi ve nöroloji tarafından yapılmaktaydı (sırasıyla; 16%,6.4%,5.9%,4.3%). Warfarin eğitimi %36,8idi.
Sonuç: Warfarin sık takip gerektiren ve komplikasyonları mortal olan bir ilaç olduğu için hasta eğitimi çok önemlidir ve hastaların en kolay ulaşabilecekleri sağlık hizmeti olan birinci basamak sağlık hizmetlerini kullanmaları yönünde teşvik edilmesi gerekmektedir.

Keywords

Kanama, INR, Mortalite, Birinci basamak sağlık hizmetleri, Warfarin

Evaluation Of The Inpatients Who Apply With High INR-Level Due To Warfarine Use- A Retrospective Descriptive Study

Abstract

Objective: In this study, we searcheddemographic analysis of complications of patients who took warfarin treatment andadmitted to our hospital with high INR levels and factors affecting mortality.
Material and Method: All patients who were admitted to our hospital for any reason, who had at least 4 INR and received warfarin treatment were included in the study. The studies were analyzed retrospectively. The hospitalization epicrisis of 187 patients was evaluated. Questions were asked about duration of warfarin use, follow-up frequency, primary health care status, changes in the floor made by the clinic, and the use of warfarin data.
Results: The study population consisted of 87 women and 100 men. The mean age of the patients was 64.1 ± 17.6 years. The most common hospitalization complaints in the whole population were bleeding (22.4%), dyspnea (18.2%), confusion (17.1%) and nausea / vomiting (9.6%). INR level was above 10 in 34.2% of the patients. The highest indication of warfarin use was AF. Hypertension was the highest comorbidity. The predictors of mortality were chest pain (HR = 3.808; p = 0.012) and hemathesis (HR = 3.688; p = 0.033), respectively. The number of patients admitted to primary care for warfarin was 23 (12.3%). Patients were followed up in cardiology, home health care, cardiovascular surgery and neurology (16%, 6.4%, 5.9%, 4.3%, respectively). The rate of people who received warfarin training was 36.8%.
Conclusion: Although warfarin is a drug that should be monitored frequently, the follow-up frequency of patients is very low.

Keywords

Bleeding, INR, Mortality, Primary Health Care, Warfarine

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