• 대한임상독성학회지
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• 제9권2호
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• pp.113-116
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• 2011

Superwarfarin, such as brodifacoum, is a highly lethal vitamin K antagonist used as a rodenticide. Brodifacoum has a particularly long half-life in the body, which ranges to several months, and therefore requires prolonged treatment with antidotal vitamin K. We experienced a case whereby an 18-year-old male was presented to the hospital with a severe bleeding disorder. It was discovered that he had ingested brodifacoum rodenticide with intent to commit suicide. Despite continual treatment with vitamin K, the bleeding disorder persisted for several months before he recovered. We report this case with literature review.

• Journal of Chest Surgery
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• 제37권5호
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• pp.448-451
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• 2004

개심술 후 폐색전증을 동반한 우심방 혈전의 발생 예는 매우 드물다. 10개월 전 심방중격결손 수술을 받았던 54세 여자 환자가 좌측 흉막통과 호흡곤란을 주소로 응급실에 내원하였다. 폐관류주사 검사에서 다발성 분절성 관류 결손 소견을 보였고 경식도 초음파 검사에서 우심방 벽에 위치하는 크고 줄기가 있는 움직이는 종괴가 발견되었다. 헤파린 치료 시작 13일 후 시행한 심초음파 검사에서 크기가 전혀 줄어들지 않아 개심술하에 종괴를 제거하였다. 병리 소견에서 우심방 기질성 혈전으로 밝혀졌고, 수술 후 환자는 별 문제 없이 회복되었으며 퇴원 후 와파린 치료를 받고 있다.

• 대한한방내과학회지
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• 제33권2호
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• pp.160-171
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• 2012

Background and Objective : Warfarin is the standard anticoagulation treatment for atrial fibrillation, venous thromboembolism (VTE), and mechanical heart valves. Close monitoring of the International Normalized Ratio (INR) is required due to the drug's very narrow therapeutic window. Many factors can affect INR levels. Drug and food interactions are frequently cited as causes of adverse events with warfarin. We discussed interactions between herbs and warfarin studied in this research. Methods : In this review, PubMed was used to search medical journals. Keywords "warfarin AND interaction" were applied. Results : 55 articles were included. The possibility of correlation between warfarin and single herbal medicines such as Salviae Miltiorrhizae Radix, Angelicae Gigantis Radix, Ginseng Radix Alba, Lycii Fructus, Ginkgo Folium, Menthae Herba, Trigonellae semen was suggested. Furthermore, some herbal compounds interacting with warfarin were reported. The conclusion of studies reporting the effect of herbal medicine on warfarin were controversial due to small size or quality of research. Conculsions : We suggest that we should prescribe therapeutic herbal medicines to patients using warfarin more carefully and do INR follow-up regularly.

• Journal of Chest Surgery
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• 제41권2호
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• pp.273-276
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• 2008

심장 정지에 있어서 체외 심폐 보조가 1983년도에 도입된 이래로 심장 정지의 치료에 응급 경피적 심폐 보조가 사용되어 왔다. 다량의 급성 폐동맥 색전증은 사망률이 높고, 특히 수술 중 발생한 경우는 외과의와 마취의에게 힘든 문제를 제기한다. 본 증례는 수술 도중에 발생한 다량의 폐동맥 색전증으로 인한 심장 정지에 대하여 효과적인 치료수단으로써 응급 체외 순환기를 사용한 56세의 여자 환자에 대하여 기술하였다. 환자는 와파린을 복용하면서 퇴원하였고, 패동맥 색전증의 재발없이 외래추적 중이다.

• 한방재활의학과학회지
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• 제20권2호
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• pp.175-181
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• 2010

Objectives : The purpose of this study is to investigate interaction and safety in administering herb-medicine with warfarin. Methods : For this study, we selected 19 patients who have been taking warfarin, from the ones that have been transferred from western hospital to oriental hospital. During their stay in the oriental hospital, we gave herb-medicine in addition to warfarin. Then we gathered informations and data on sex, age, main indications, and International Normalized Ratio(INR) values of selected patients through Electronic Medical Records(EMR) of Dong-Guk university hospital. Accordingly, we compiled all of the above data for a period of 10 days prior and 10 days post admission(western hospital period and oriental hospital period, respectively). Results and Conclusions : The statistical analysis of the data have revealed that there was no significant change of INR values after giving herb-medicine with warfarin(p=0.586). The result shows that administration of herb-medicine with warfarin is safe and has little drug interaction. However, this study was carried out on small sample size and the interaction with other drugs and various kinds of herb-medicine was not considered. Although we attained a restrictive result from this study, we are able to suggest the safety about co-administration of herb-medicine and warfarin.

• 약학회지
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• 제49권2호
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• pp.134-139
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• 2005

Warfarin is a widely used oral anticoagulant agent used to treat thromboembolic disease. The purpose of this study was to develop the efficient assay method of warfarin sodium i n human plasma and to assess the pharmacokinetic profile of the warfarin in healthy Korean volunteers. The pharmacokinetics of warfarin administered orally was evaluated after a dose of 10 mg. Warfarin in plasma was assayed using a specific HPLC method with UV absorbance at 304 nm. AUC was 46.33${\pm}9.95{\mu}g/ml.hr$, $C_{max}$ $1.22{\pm}0.22{\mu}g/ml, $T_{max}$$2.50{\pm}1.41$ hr and half-life $43.49{\pm}4.33$ hr. $T_{max}$ was slightly shorter than that in Caucasian (3~9 hr), whereas the half-life was longer than that in Caucasian (10~45 hr, mean: 36 hr). These results suggest that warfarin may have a longer duration in Korean than in Caucasian.

• 한국임상약학회지
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• 제23권3호
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• pp.206-212
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• 2013

Purpose: The aim of this study was to investigate the effect of nimodipine on the pharmacokinetics of warfarin after oral and intravenous administration of warfarin in rats. Methods: Warfarin was administered orally (0.2 mg/kg) or intravenously (0.05 mg/kg) without or with oral administration of nimodipine (0.5 or 2 mg/kg) in rats. The effect of nimodipine on the P-glycoprotein as well as cytochrome P450 (CYP) 3A4 activity was also evaluated. Results: Nimodipine inhibited CYP3A4 enzyme activity with 50% inhibition concentration ($IC_{50}$) of $10.2{\mu}M$. Compared to those animals in the oral control group (warfarin without nimodipine), the area under the plasma concentration-time curve (AUC) of warfarin was significantly greater (0.5 mg/kg, P<0.05; 2 mg/kg, P<0.01) by 31.3-57.6%, and the peak plasma concentration ($C_{max}$) was significantly higher (2 mg/kg, P<0.05) by 29.4% after oral administration of warfarin with nimodipine, respectively. Consequently, the relative bioavailability of warfarin increased by 1.31- to 1.58-fold and the absolute bioavailability of warfarin with nimodipine was significantly greater by 64.1-76.9% compared to that in the control group (48.7%). In contrast, nimodipine had no effect on any pharmacokinetic parameters of warfarin given intravenously. Conclusion: Therefore, the enhanced oral bioavailability of warfarin may be due to inhibition of CYP 3A4-mediated metabolism rather than P-glycoprotein-mediated efflux by nimodipine.

• 한국임상약학회지
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• 제30권4호
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• pp.243-249
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• 2020

Background: Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. Methods: We developed "WafarinTalk" as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. Results: We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. Conclusion: This study showed that warfarin-related information could be provided to patients through a messenger application-based chatbot.

• Journal of Chest Surgery
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• 제41권4호
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• pp.430-438
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• 2008

배경: 기계 심장판막 대치술 후 발생하는 혈전성 합병증을 방지하기 위해 항응고제 치료로써 와파린을 환자에게 투여한다. 이때 환자에 따른 적절한 와파린 용량을 결정하기 위한 지표로서 INR을 참고하는데 통상 대동맥판막은 $2.0{\sim}3.0$, 승모판막은 $2.5{\sim}3.5$가 참고치로서 받아들여지고 있다. 하지만 임상 경험상 대부분의 환자에서 이 수치로 유지하였을때 출혈성 합병증(비출혈, 혈뇨, 자궁출혈, 뇌출혈 등)이 빈번하게 발생하여 참고치보다 더 낮게 유지하는 경우가 많다. 이에 본원에서는 기계 심장판막 환자들을 후향적으로 조사하여 혈전성 합병증의 빈도가 낮은 적정한 INR을 알아보고자 한다. 대상 및 방법: 1984년 1월부터 2007년 2월까지 이엽성 기계 심장판막 대치술을 받고 생존한 311명의 환자를 대상으로 후향적으로 조사하였다. 대동맥판막치환 환자들(60명)은 INR $1.5{\sim}2.0$ (1군), $2.0{\sim}2.5$ (2군), 2.5 (3군) 이상의 세 군으로 나누고 승모판막치환(171명)이나 승모판막과 대동맥판막을 동시에 치환한 환자들(80명)은 INR $1.5{\sim}2.0$ (1군), $2.0{\sim}2.5$ (2군), $2.5{\sim}3.0$ (3군), 3.0 (4군) 이상의 네군으로 나누어 혈전성 합병증 발생률, 중요출혈성합병증 발생률을 조사하여 각각의 생존함수를 비교하였다. 결과: 대동맥 판막치환 환자 중 혈전성 합병증은 2명, 출혈성합병증은 4명이 발생하였고 세군의 혈전성 합병증의 생존함수의 차이는 관찰되지 않았고 출혈성 합병증의 생존곡선에서 1, 2군과 3군의 차이가 관찰되었다. 승모판막치환이나 승모판막과 대동맥판막을 동시에 치환한 환자들 중 혈전성 합병증은 13명, 출혈성 합병증은 15명이 발생하였고 네 군의 혈전성 합병증의 생존함수의 차이는 관찰되지 않았고 출혈성 합병증은 1, 2군과 3, 4군에서 차이를 보였다. 결론: 모든 판막에서 INR이 $1.5{\sim}2.5$ (1군과 2군)로 유지한 환자들이 그 이상으로 유지한 환자들보다 혈전성 합병증에서 차이를 보이지 않았고 출혈성 합병증에서 유의하게 감소하는 양상을 보여 이엽성 기계판막에서 적정한 INR은 $1.5{\sim}2.5$로 유지하는 것이 바람직하다고 판단된다.

• Tuberculosis and Respiratory Diseases
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• 제65권3호
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• pp.212-215
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• 2008

본 증례는 와파린을 복용하던 72세 여자가 기침을 심하게 하던 중 하복부 통증과 압통을 보이는 복부 팽만이 발생하여 복부 전산화단층촬영을 통해 복직근초 혈종을 진단한 경우이다. 복직근초 혈종은 매우 드물지만 항응고제를 복용하는 고령 환자나 분만을 했거나 복부 수술을 받은 경우 등에서 발생할 수 있고, 드물게 기침에 의해서도 발생할 수 있다. 따라서 이런 환자에서 심한 복통이나 복부 종물이 관찰되는 경우 그 가능성을 한 번쯤 생각해보아야 하겠다. 전산화단층촬영은 복직근초 혈종 진단의 특이성과 민감도가 높아 진단에 도움이 되며 대부분은 보존적인 치료만으로 회복되므로 본 질환의 위험인자와 진단방법에 대해 숙지하고 정확한 진단을 하는 것이 무엇보다도 중요하겠다.