Ömer Furkan DEMİR, Fatih LEVENT, Mustafa Ahmet HUYUT, Ozlem ARİCAN OZLUK

Warfarin kullanma zamanı metalik protez kapak hastalarında terapötik aralıktaki INR değer süresini etkiler mi?

Amaç : K vitamin antagonisti olan Varfarin metalik kalp kapaklı hastalarda onaylanmış oral antikoagulan tedavidir. Etkin antikoagulan tedaviyi sürdürmeyi zorlayan birçok faktör nedeniyle bu hastaların sık aralıklarla INR takibine alınması önerilmektedir.Bu çalışmanın amacı varfarin kullanma zamanının antikoagulasyona etkisi olup olmadığını araştırmaktır. Materyal ve metod: Metalik protez kapaklı toplam 60 hasta çalışmaya dahil edildi. Tüm hastalara ilk ayda varfarini saat 19:30 -20:00 arasında, ikinci ayda saat 09:30 ve 10:00 arasında alması söylendi.Hastalardan takip süresinde 15 günde bir INR ölçümü yapıldı.Birinci ve ikinci ay terapötik aralıktaki zaman yüzdesi (TTR) değerleri (sırasıyla birinci ve ikinci TTR) Rosendaal metoduyla hesaplandı. Sonuçlar:Ortalama yaş 59.6 ± 9.6 yıldı.%36,7'si (n:22) erkekti.Birinci ve ikinci TTR değerleri arasında anlamlı fark bulunmadı (66.23 ± 40.7% vs 64.12 ± 41.13%, p=0.783).Birinci aydaki ortalama INR değeri ikin aydakinden anlamlı olarak daha düşüktü (2.73 ± 0.53 vs 3.06 ± 0.47, p=0.001). Karar:Çalışma sonuçları varfarin kullanma periyodunun etkin antikoagulasyon sağlanan toplam zamana bir etkisi olmadığını göstermiştir. Bunun birlikte sabah varfarin kullanımı daha yüksek INR değerlerine neden olmaktadır.

Anahtar Kelimeler:

warfarin, Uluslararası normalleştirilmiş oran, farmakokinetik

DOES THE TIMING OF WARFARIN INGESTION AFFECT THE TIME IN THERAPEUTIC RANGE IN PATIENTS WITH METALLIC PROSTHETIC VALVE?

Aim: Warfarin , a vitamin K antagonist, is the only approved oral agent to provide anticoagulation in patients with metallic prosthetic valves. Since effectively initiating and maintaining anticoagulation is challenging due to various factors , those patients undergo frequent periodic INR testing. The aim of this study was to investigate the effect of the timing of warfarin ingestion on the stability of anticoagulation. Materials and Methods: A total of 60 patients with metallic prosthetic valves were included in the study. First, all the patients were informed to take warfarin between 19:30 and 20:00 during the first month, then to take warfarin between 09:30 and 10:00 during the second month. All the patients underwent INR monitoring once every 15 days during the follow-up period. The time in therapeutic range (TTR) values for the first month and second month ( referred to as ‘first TTR’ and ‘second TTR’, respectively) were calculated separately using the Rosendaal method. Results: The mean age ( ± SD) of the patients was 59.6 ± 9.6 years and 36.7% (n=22) were male. There was no significant difference between the first TTR and second TTR values of the patients (66.23 ± 40.7% vs 64.12 ± 41.13%, p=0.783). The mean INR value in the first month was found to be significantly lower than in the second month (2.73 ± 0.53 vs 3.06 ± 0.47, p=0.001). Conclusion:.The study results showed that the timing of warfarin ingestion did not affect the stability of anticoagulation although taking the warfarin in the morning provided higher INR values.

Keywords:

warfarin, international normalized ratio, pharmacokinetic,

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