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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

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학술저널
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한국임상약학회 한국임상약학회지 한국임상약학회지 제20권 제2호
발행연도
2010.1
수록면
159 - 164 (6page)

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Radiofrequency ablation (RA) is being used to manage atrial fibrillation (AF) with patients failed at the 1st-line anti-arrhythmic medications. Patients undergoing this procedure are at increased risk of thromboembolism after ablation, and anticoagulation management surrounding the ablation remains controversial. Although no conclusive recommendations can be made,published guidelines and data support therapeutic anticoagulation with warfarin. The purpose of this study was to analyze effectiveness of current therapy and to find factors fluctuate International Normalized Ratio (INR) values in patients undergone RA followed by anticoagulation service (ACS). Retrospective review was conducted utilizing database in a hospital. Among 110 patients under warfarin around ablation between January 2006 to September 2007, 54 patients were selected and allocated into 2 groups: Group A included 47 who discontinued warfarin after ablation, while 7 in B continued the medication. Information on demographics, amount and length of warfarin dosing, INR values and measuring frequencies, and the causing factors on INR fluctuation were abstracted. Differences were analyzed using chi-squared test, Fisher's Exact test, and unpaired Student t-test. Mean amount of warfarin before and after surgery was 4.0 mg, 4.1 mg in Group A and was 5.1 mg,4.6 mg in Group B, respectively. Average duration of warfarin doing before ablation was 73.7 days in Group A, 129.9 days in B with no significant difference (p = 0.312). The duration time of warfarin on groups after ablation lasted several months. The number of checking INRs was 4.1 and 7.6, respectively. Inter-individual variability of INR fluctuations were 2.1 ± 0.6 in Group A and 2.2 ± 0.7 in B which were not significantly different (p = 0.062). 164 cases of decreased INR were: ‘omission in taking medication, stressfulness and headache, ‘increased intake of high vitamin K foods’, ‘lifestyle change of increased physical activities’, and ‘increase of food-intakes’. To the contrary, 36 cases of increased INR were: ‘reduce of food-intake’, ‘use of non-prescription drugs’, ‘reduction in physical activities’, and ‘excessive restriction on food-intake’, consecutively. In conclusion,the study validated therapeutic outcomes of RA patients who we treated with standard guideline and demonstrated 9 factors of INR fluctuations in the patient. A well-trained, pharmacist-monitored anticoagulation service could reduce the risk of adverse effects and prevent complications in patients with AF around RA operation
#atrial fibrillation #radiofrequency ablation #warfarin #anticoagulation service #INR

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참고문헌 (20)

참고문헌 신청
/ 2001 / American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing google schola / 2006 / AHA 2006 Guidelines for the Management of Patients with Atrial Fibrillation / 2006 American Heart Association, Inc. : e257 ~ e354 google schola Benjamin EJ / 1998 / Impact of atrial fibrillation on the risk of death / Circulation 98 : 946 ~ 952 google schola Bubien RS / 1996 / Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias / Circu google schola Burkiewicz JS / 2005 / Effect of access to anticoagulation management services on warfarin use in patients with atrial fibrillation / Pharmacotherapy 25 : 1062 ~ 1067 google schola

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