Warfarin in the Emergency Service: Drug Interactions and Clinical Considerations

Year 2024, , 234 - 239, 01.07.2024

Tugce Uskur , Oya Güven , Merve Demireller

https://doi.org/10.18663/tjcl.1470923

Abstract

Aim: Drug-drug interactions (DDIs) are common occurrences where one drug influences the blood concentrations or efficacy of another. Warfarin, known for its narrow therapeutic index, carries a heightened risk of severe drug interactions.
Material and Methods: We retrospectively analyzed the records of 211 patients using warfarin at the Emergency Health Services clinic of Kırklareli Training and Research Hospital from January 1, 2020, to December 31, 2020. Patient demographics and drug regimens were documented, and drug interaction assessments were conducted using the drugs.com database.
Results: Among the 211 patients, 17 exhibited signs of bleeding, including 5 with major bleeding and 12 with minor bleeding. Of these, 129 had INR values exceeding 2.5, while 82 had INR values below 2.5. Notably, 11 of the 17 bleeding patients had INR values above 2.5, with an average INR of 3.69. Analysis revealed that the 211 patients collectively used 111 different drugs, with an average of 3.81 drugs per prescription. Intriguingly, 33 of these drugs exhibited major, moderate, or minor inter-actions and were prescribed to 174 patients.
Conclusion: In conclusion, cautious and selective prescription of medications is warranted for patients receiving warfarin due to the potential for significant drug interactions.

Keywords

warfarin, drug-drug interaction, emergency medicine

Acil Serviste Warfarin: İlaç Etkileşimleri ve Klinik Önlemler

Abstract

Amaç: İlaç-ilaç etkileşimleri (İİE'ler), bir ilacın diğerinin kan konsantrasyonlarını veya etkinliğini etkilediği yaygın durumlardır. Dar terapötik indeksi ile bilinen warfarin, ciddi ilaç etkileşimleri açısından yüksek risk taşır.
Gereç ve Yöntem: 1 Ocak 2020 ile 31 Aralık 2020 tarihleri arasında Kırklareli Eğitim ve Araştırma Hastanesi Acil Sağlık Hizmetleri kliniğinde warfarin kullanan 211 hastanın kayıtları retrospektif olarak analiz edildi. Hasta demografileri ve ilaç rejimleri belgelendi ve ilaç etkileşim değerlendirmeleri drugs.com veritabanı kullanılarak yapıldı.
Bulgular: 211 hastadan 17'sinde kanama belirtileri görüldü; bunlardan 5'i büyük, 12'si küçük kanamalardı. 129 hastanın INR değerleri 2,5'in üzerindeyken, 82 hastanın INR değerleri 2,5'in altındaydı. Kanama yaşayan 17 hastadan 11'inin INR değeri 2,5'in üzerindeydi ve ortalama INR değeri 3,69'du. Analiz sonucunda, 211 hastanın toplamda 111 farklı ilaç kullandığı ve reçete başına ortalama 3,81 ilaç bulunduğu tespit edildi. İlginç bir şekilde, bu ilaçların 33'ü majör, orta veya minör etkileşimler gösterdiği ve 174 hastaya reçete edildiği görüldü.
Sonuç: Sonuç olarak, warfarin kullanan hastalar için ilaç etkileşimleri potansiyeli nedeniyle ilaç reçetelendirmesi dikkatli ve seçici bir şekilde yapılmalıdır.

Keywords

varfarin, ilaç-ilaç etkileşimi, acil servis

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Kırklareli University Faculty of Medicine (protocol codeand date of approval 03/04/2024 - P202400011).

Thanks

Sayın Editör, Makalemi değerlendirmeniz için göndermekten memnuniyet duyuyorum. Bu süreçte gösterdiğiniz ilgi ve alaka için teşekkür ederim. Umarım makalem derginiz için uygun bulunur ve bilimsel camiaya katkıda bulunur. Her türlü soru ve geri bildirime açığım ve sürecin her aşamasında işbirliği içinde olmayı dört gözle bekliyorum. Saygılarımla, Dr. Tuğçe Uskur

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