Varfarin Tedavisi Alan Serebrovasküler Hastalığı Olan Hastalarda Terapötik Aralıkta Olma Oranlarının Değerlendirilmesi

Year 2021, Volume: 12 Issue: 43, 88 - 93, 19.08.2021

Neslihan Eşkut , Pınar Tamer , Özge Yılmaz Küsbeci , Ceyla Ataç , İpek İnci

https://doi.org/10.17944/mkutfd.937769

Abstract

Amaç: Varfarin tedavisinin etkinliği, Terapötik Aralıkta Olma Zamanı (TTR) ile doğrudan ilişkilidir. Bu çalışmada, inme polikliniğinde izlenen warfarin kullanan hastalarda etkinlik ve hedefe ulaşma oranlarının belirlenmesi amaçlanmıştır.Yöntem: İnme polikliniğinde izlenen, varfarin kullanan 103 hasta, retrospektif olarak değerlendirildi. Varfarin kullanım süreleri, ve endikasyonlarıyla trombotik veya hemorajik komplikasyonları kaydedildi. Hedef INR değeri mekanik kapaklı hastalarda 3.0-3.5, diğer endikasyonlar için 2.0-3.0 arasında belirlendi.Bulgular: Çalışmaya 47’si erkek 56’sı kadın olmak üzere, ortalama yaşları 67.14 ± 14.19 olan 103 hasta dahil edildi.Varfarin kullanım endikasyonları sırasıyla hastaların %61,6’sında non-valvular atrial fibrilasyon, %12.62’sinde eko kardiyografide (EKO) akinetik/hipokinetik alan, %8.74’ünde trombofili, %3.88’inde metalik protez kapak, %6.79’unda sık geçici iskemik ataklar, %5.82’sinde atrial fibrilasyonla birlikte EKO’da hipokinetik alan ve % 0.87’sinde vertebral arter diseksiyonuydu. Hastaların %46.8’inin iyi kontrolde olduğu, ortalama TTR’nin %64.09 olduğu saptandı; ayrıca, TTR %36.8’inde %100 idi. İkisinde intraserebral kanama olan 10 hastada (%9.70) minör/majör hemorajik olay kaydedildi.Sonuç: Bu çalışmada saptanan ortalama TTR değeri, ülkemizde bildirilen orandan oldukça yüksektir. Çalışma bulgularımız, yakın izlemin inmeli hastalarda çok önemli ve hayati olduğunu göstermektedir. Varfarin kullanan inme hastalarının düzenli takibinin ve hastaları bilgilendirmenin optimal antikoagülasyon sağlanmasına ve komplikasyonları önlemeye yardımcı olacağına kanısındayız.

Keywords

Varfarin, Etkinlik, Antikoagulasyon, İskemik Serebrovasküler Hastalık

Evaluation of Time in Therapeutic Range in Patients with Cerebrovascular Disease Receiving Treatment with Warfarin

Abstract

Objective: The efficacy of warfarin therapy correlates with the Time in Therapeutic Range (TTR). This study aimed to investigate the efficacy and target achievement rates in patients using warfarin who were followed up in stroke outpatient clinics.Methods: In this study, 103 patients who had been under warfarin treatment were retrospectively evaluated. Duration and indications for warfarin use, thrombotic or hemorrhagic complications were recorded. Target INR value was 3.0-3.5 in patients with mechanical valves and 2.0-3.0 in those using warfarin for other indications.Results: In this study, 103 patients with a mean age of 67.14±14.19, 47 men and 56 women, were included. Indications for warfarin use, respectively, were non-valvular atrial fibrillation (AF) in 61.6% of the patients, akinetic/hypokinetic segment on echocardiography (ECHO) in 12.62%, thrombophilia in 8.74%, metallic prosthetic valve in 3.88%, frequent transient ischemic attacks in 6.79%, a hypokinetic segment on ECHO with atrial fibrillation in 5.82% and vertebral artery dissection in 0.87%. 46.8% of the patients were determined to be in good control, with a mean TTR of 64.09%; also, TTR was 100% in 36.8% of them. Minor/major hemorrhagic event was noted in 10 patients (9.70%), two of whom had an intracerebral hemorrhage.Conclusion: The mean TTR value detected in this study is considerably higher than the rate reported in our country. Findings of this study suggest that close monitoring is paramount of importance and vital in patients with stroke. Regular monitoring of stroke patients using warfarin will be beneficial in terms of informing patients, providing optimal anticoagulation and preventing complications.

Keywords

Warfarin, Ishemic Cerebrovascular Disease, Anticogulation, Efficacy, Efficacy

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