Effect of Combined Use of Warfarin with Other Drugs on Anticoagulation in Patients

doi:10.12114/j.issn.1007-9572.2018.00.071

Abstract

Abstract: Objective　To explore the causes of changes in international normalized ratio（INR） in inpatients receiving warfarin in combination with other drugs for anticoagulation and to offer corresponding solutions.Methods　We collected and analyzed the medical records of the inpatients receiving warfarin anticoagulation therapy in a hospital during January 2014 to December 2016.Based on referring to the warfarin package insert and Chinese Expert Consensus on Warfarin Anticoagulation Therapy，we identified the drugs potentially interacted with warfarin，and examined the incidence of bleeding possibly caused by the combined use of warfarin and other drugs.In particular，we detailedly analyzed those with INR>3.00 or with a daily increase of 0.50 in INR undergoing monitoring of INR.Results　Totaled 48 cases were included in the analysis.The analysis of the medications showed that：（1） 15 types of drugs possibly increased the action of warfarin（such as levofloxacin， aspirin enteric-coated tablets， atorvastatin calcium tablets and so on），and 4 types of drugs possibly reduced it（such as hydrochlorothiazide tablets， spironolactone tablets and so on）.（2） Of these 19 types of drugs，warfarin was administered in combination with 1 type of drug，2 types of drugs，3 types of drugs，4 or more types of drugs in 10 cases，8 cases，11 cases，12 cases，respectively.（3） Warfarin was administered in combination with none of these 19 types of drugs in 7 cases.Among 43 cases receiving the monitoring of INR〔average monitoring times of （3.2±1.4）〕，10 had a daily increase of 0.50 in INR，6 had bleeding，involving 8 types of drugs.Conclusion　When warfarin is administered with other drugs for anticoagulation，drugs that may enhance the effect of warfarin include levofloxacin， aspirin enteric-coated tablets， atorvastatin calcium tablets， etc.drugs that may weaken the effect of warfarin include hydrochlorothiazide tablets， spironolactone tablets， etc.the INR should be monitored intensively.In that case，the therapy can be adjusted timely based on the response of the patients.All these are for the improvement of the safety and rationality of clinical medication.

Key words: Warfarin, Inpatients, Drug interactions, Anticoagulants

摘要： 目的　探讨华法林在对住院患者行抗凝治疗时联用其他药物对抗凝作用的影响及处理方法。方法　收集某院2014年1月—2016年12月服用华法林的住院患者病历信息，以华法林的药品说明书和《华法林抗凝治疗的中国专家共识》为参考依据，总结出可能与华法林存在药物相互作用的药品，分析可能由于药物相互作用导致出血的不良反应发生情况，重点监测平均每日国际化标准比值（INR）增加>0.50的患者及INR>3.00的患者。结果　使用华法林患者48例。合并用药情况：应用可能增强华法林作用的药物15种（如左氧氟沙星、阿司匹林肠溶片、阿托伐他汀钙片等），可能减弱华法林作用的药物4种（如氢氯噻嗪片、螺内酯片等）；未与19种药品合并用药的有7例；存在1种合并用药的有10例，存在2种合并用药的有8例，存在3种合并用药的有11例，存在4种及以上合并用药的有12例。43例患者进行了INR监测，INR平均监测次数为（3.2±1.4）次，其中10例患者平均每日INR增加>0.50，导致出血的患者有6例，涉及药物共8种。结论　华法林是一个比较特殊的抗凝药品，可能增强华法林作用的药物有左氧氟沙星、阿司匹林肠溶片、阿托伐他汀钙片等，可能减弱华法林作用的药物有氢氯噻嗪片、螺内酯片等，应加强INR监测，及时调整用药方案，提高临床用药的安全性与合理性。

关键词: 华法林, 住院病人, 药物相互作用, 抗凝药

CAI Liqiu,YANG Lixiong. Effect of Combined Use of Warfarin with Other Drugs on Anticoagulation in Patients[J]. Chinese General Practice, 2018, 21(33): 4114-4117. DOI: 10.12114/j.issn.1007-9572.2018.00.071.
蔡丽秋,杨丽雄. 住院患者华法林与其他药物联用对抗凝作用的影响研究[J]. 中国全科医学, 2018, 21(33): 4114-4117. DOI: 10.12114/j.issn.1007-9572.2018.00.071.

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