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アセトアミノフェンや他の危険因子 過剰なワルファリン 抗凝固薬
E M Hylek1, H Heiman, S J Skates
1Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
JAMA
|March 13, 1998
まとめ
アセトアミノフェンの使用は,過剰なワルファリンの抗凝固作用 (上昇したINR) の重要で認識されていない原因です. 他の危険因子には,新しい薬,悪性腫瘍,病気,および間違ったワルファリン用量が含まれ,INRモニタリングを増加させる必要があります.
科学分野:
- 薬理学 薬理学とは
- クリニカル・メディシン 臨床医学
- 患者の安全性について
背景:
- ワルファリンは,血栓栓塞栓症の予防に不可欠ですが,特に4.0以上の国際正常化比率 (INR) で,出血の重大なリスクがあります.
- 過剰な抗凝固の原因を特定することは,患者の安全管理と臨床実務における有害事象の予防に不可欠です.
- 高いINR (4.0以上) は,ウォルファリン療法に関連する出血リスクを軽減するために注意深く管理する必要があります.
研究 の 目的:
- 診療室での6.0を超える国際標準化比率 (INR) の主な原因を調査し,特定する.
- ワルファリン療法を受けている患者の過剰抗凝固に寄与する特定の危険因子を決定する.
- 危険に高いINR値の予防可能な原因を強調することによって,臨床実務を啓発する.
主な方法:
- 外科医の抗凝固剤治療ユニットでケース・コントロール研究が行われました.
- 目標INR2.0~3.0の1ヶ月以上ワルファリンを投与した患者を前向きに追跡した.
- 症例 (INR > 6.0) と対照群 (INR 1.7-3.3) を24時間以内にインタビューし,薬物使用,食事,病気,アルコール消費などの要因を評価した.
主要な成果:
- アセトアミノフェンの摂取は,6.0以上のINRと用量依存の関連性を示し,高用量 (≥9100 mg/w) でリスクが10倍に増加しました.
- 独立した関連因子には,新しい増強薬 (OR 8.5),進行性悪性腫瘍 (OR 16.4),下痢疾患 (OR 3.5),経口摂取量の減少 (OR 3.6),処方された量以上のワルファリン摂取 (OR 8.1) が含まれていた.
- より高いビタミンK摂取量 (OR 0.7) と通常の適度なアルコール摂取量 (OR 0.2) は,過剰抗凝固のリスクの低下と関連していました.
結論:
- アセトアミノフェンは,ウォルファリンを服用している外来患者における過剰抗凝固への認識されていない寄与因子です.
- 薬物相互作用や患者に関連する要因を含む他のいくつかの重要な臨床リスク要因が特定されました.
- INRの強化されたモニタリングとリスクファクターの修正は,危険な高い抗凝固値の発生率を減らすために推奨されます.
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