• Biomolecules & Therapeutics
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• 제14권4호
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• pp.189-193
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• 2006

This study was designed to assess the distribution of cytochrome P450 2E1 (CYP2E1) polymorphism among Korean patients on warfarin therapy. CYP2E1 polymorphism was analyzed at 5' flanking region of CYP2E1 gene using restriction fragment length polymorphism method. Patient characteristics including the measured internal normalized ratio (INR) were also evaluated. Based on the warfarin dose and the bleeding cases, the patients were grouped as the regular dose control, the regular dose bleeding, the low dose control, and the low dose bleeding. Total 96 patients were evaluated for both Pst I and Rsa I loci of the CYP2E1 gene and the results showed that both loci were tightly linked. Thirty-three patients(34.4%) were heterozygotes and 4 patients(4.2%) were homozygote. There was no significant difference in patient characteristics in the dose and bleeding case groups. CYP2E1 polymorphism showed a little difference among the groups but was not statistically significant, however, lower INR value was observed in homozygote genotype groups. It was also revealed that genotype allele frequencies of CYP2E1 in Korean was close to other Asian groups but was significantly different from other Caucasian and African-American populations.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.219-224
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• 2018

New oral anticoagulants (NOACs) are now widely used for the prevention and treatment of venous thrombosis, and for the prevention of stroke and systemic embolism in patients with atrial fibrillation. As compared with warfarin, NOACs have the advantage of rapid onset of action and less drug interaction. However, they carry a higher risk of gastrointestinal (GI) bleeding than warfarin. The risk of GI bleeding in patients using NOACs varies according to the type and dose of the drug. By contrast, apixaban and edoxaban are reported to carry similar risks as warfarin, and the risks with dabigatran and rivaroxaban are higher than that with warfarin. In patients using NOACs, old age, impaired renal function, impaired liver function, concurrent use of antiplatelet agents, and nonsteroidal anti-inflammatory drugs are considered major risk factors of GI bleeding, and gastroprotective agents such as histamine-2 receptor antagonist and proton pump inhibitor have preventive effects. To prevent GI bleeding associated with NOACs, the characteristics of each NOAC and the risk factors of bleeding should be recognized.

• Journal of Korean Biological Nursing Science
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• 제14권1호
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• pp.66-75
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• 2012

Purpose: This study was conducted to measure medication adherence and perceptions of anticoagulation therapy and its relationship to patients taking warfarin. Methods: in a cross-sectional survey, 150 patients taking warfarin who had visited an outpatient clinic of a cardiovascular center in Seoul were included as research subjects. Medication adherence was measured using a visual analogue rating scale (VAS). Barriers and attitudes toward adherence, and oral anticoagulation knowledge, were measured using a structured questionnaire. Participants' medical records also were reviewed to identify clinical characteristics. Results: About one third of the participants (30.7%) reported medication adherence as 100%. The major barriers to adherence were identified as "Forgetting the time of medication" and "Not carrying their medication". Overall attitudes toward medication adherence were high, but oral anticoagulation therapy knowledge was low. To determine the relationship of medication adherence and perceptions of anticoagulation therapy, participants were stratified into three groups, based on their medication adherence levels (high adherence, moderate adherence, low adherence). Participants in the high adherent group more likely to be older (OR: 1.04, 95% CI: 1.005-1.071) and to have positive attitudes toward medication adherence (OR: 1.12, 95% CI:1.013-1.229) compared to the other two groups. Conclusion: The results show that age and attitude exerts significant influence on medication adherence in patients taking warfarin.

• Journal of Chest Surgery
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• 제38권11호
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• pp.761-772
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• 2005

배경: 인공심장판막 시술 후에 혈전색전증의 위험성을 감소시키기 위래서 치료범위의 INR을 유지하는 것이 중요하다. 이 연구의 목적은 약사에 의해서 운영되는 anticoagulation service (ACS)을 받는 한국 인공심장판막 외래환자에서 실제적인 용량 가이드라인을 제시하고자 하였다. 대상 및 방법: 1997년 3월에서 2000년 9월까지 서울대학교병원에서 ACS를 방문한 모든 환자의 의무기록을 후향적으로 검토하였다. 수술 후 6개월이 경과된 환자로 INR 2.0미만과 INR 3.0초과가 한 번 이상 있는 환자의 자료를 대상으로 하였으며 이전의 INR이 안정화되었고, 복약순응도가 확인되고, warfarin과 알려진 약물 또는 상호작용이 없는 경우로 목표 INR에 도달하기 위해서 용량 조절을 필요로 한 증례(총 688명, 1,782회 방문)를 분석하였다. Warfarin용량 조절 가이드라인을 제시하기 위해서 대동맥 판막치환술과 승모판 또는 이중판막 치환술을 받은 환자를 구별하여 각각 용량 조절 전의 INR, 평균 조절된 용량, 조절 후의 INR을 조사하였다. 결과: 이 연구에서는 1주일 총 투여량의 변화량(mg)에 근거한 warfarin 용량 조절(가이드라인 I)과 비율에 근거한 1주일 총 투여량 조절 가이드라인(가이드라인 II)을 제시하였고 가이드라인 I과 가이드라인 II의 유효성도 평가하였다. 모든 환자 군에서 가이드라인 I이 가이드라인 II보다 우수하였지만 가장 흔히 사용되는 중등도의 용량(1주 총 투여량$23\~47mg$)을 투여 받는 환자에서는 두 가이드라인 사이에 유의한 차이가 없었다 결론: 이 연구에서 제시된 가이드 라인은 심장판막수술을 받은 외래 환자에서의 warfarin 용량 조절에 유용할 것으로 생각된다.대한 치료 순응도가 높아졌다. 후 동율동 전환율이나 좌심방 수축능 회복에 좋은 결과를 보여주었다 그러나 향후 대상환자들에 대한 중장기적인 추적 관찰이 필요하리라 생각한다.pm1.6$일째에 관상동맥조영술을 시행하여 모든 도관의 개존율$(100\%=57/57)$을 확인하였다 수술 전 중재 술을 시행한 1개소에서는 중재술 부위의 재협착소견이 보여 수술 후 조영술시 재풍선확장술로 치료하였다. 수술 후 추적관찰(평균 $25\pm26$개월)동안 1예에서 심부전으로 사망하였다. 생존한 환자 24예에서 술 후 평균 $9.6\pm3$개월째에 관상동맥조영술을 시행하였고 이식도관이 string 징후를 보인 1예를 제외하고 모두 개존(56/57)되어 있었으며, 약물용출형 스탠트를 시행하기 이전의 12예의 중재술 중 2예에서 $50\%$ 이상의 스텐트 협착이 있었으나 흉통의 재발은 없었다. 결론: 하이브리드 관상동맥 우회 술은 수술위험도를 낮추기 위하여 최소절개 관상동맥우회술과 병합하여 시도될 수 있을 뿐 아니라, 선택적 환자들에서는 정중 흉골절개 관상동맥우회술과 병합하여 수술관련 유병률을 낮추고 심근의 완전 재관류화를 도모할 수 있었다.호도에서 가장 적절한 방법으로 사료된다.비위생 점수가 유의적으로 높은 점수를 나타내었다. 조리종사자의 위생지식 점수와 위생관리 수행수준의 상관관계를 조사한 결과, 위생지식의 기기설비위생은 위생관리 수행수준의 합계(p<0.01)에서 유의적인 상관관계(p<0.01)를 나타내었으며, 위생지식의 식중독 및 미생물은 위생관리 수행수준의 개인위생(p<0.01)과 유의적인 상관관계가 있는 것으로 나타났다 위생지식의 점수합계는 개인위생(p<0.05)과 식중독 및 미생물(p<0.

• 대한한방내과학회지
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• 제31권3호
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• pp.675-687
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• 2010

Objective : Interaction of warfarin with herbal medicines still remains controversial. The aim of this study was to examine the effect of herbal medicines which contain ginseng on PT INR in patients being treated with warfarin. Method : We studied patients who take herbal medicines which contain ginseng with warfarin during their hospitalization. We retrospectively investigated the effect of herbal medicines which contain ginseng. 10 patients were assigned to receive one of the following adjuncts: Group A (n=4) that received Bojungikkitang-gagam, Group B (n=2) that received Ukgunjatang-gagam, and Group C (n=4) that received Shihogyeji-tang, Gamiondam-tang, Gwininaanshim-tang, and Saengpe-san together. We then investigated changes of PT INR in each group. Result : In group A, there were diminutions of PT INR in 3 cases, and increment in 1 case. In group B, there were increments of PT INR in both cases. In group C, there were increments of PT INR in 3 cases and there was no big change in 1 case. Conclusion : In this study, we found that the interaction of combined herbal medicine is very complicated. So, we must study further more study about interactions of combined herbal medicine on PT INR.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1023-1030
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• 1999

This is a retrospective study of 42 pregnancies from 33 women with prosthetic heart valves who were on anticoagulation regimen prior to or during their pregnancy. Material and Method: Of the 17 women with bioprosthesis, 15 had 21 pregnancies following cessation of the anticoagulation therapy which resulted in the delivery of 20 healthy babies and 1 abortion. Remaining 2 had 3 pregnancies maintained with heparin, resulting in 2 healthy babies and 1 spontaneous abortion. Result: Among 16 women with mechanical heart valves, there were 7 pregnancies during which warfarin was used and this was associated with 4 fetal wastages(2 therapeutic abortion, 1 spontaneous abortion and 1 stillbirth with cerebral hemorrhage). However, in pregnancies where heparin was used, there was no fetal wastage. A patient who did not take anticoagulant for the first trimester and took warfarin for the remaining period and a patient who did not take anticoagulant during pregnancy delivered normal babies. There was an other fetal wastage in a patient on anti-platelet therapy for the first trimester and warfarin therapy for the remaining periods. There was 1 minor petechial complication in a heparin administered group. Conclusion: The study indicates that woman with bioprosthetic heart valves can go through pregnancy without undue risks or complications. On the other hand, the use of warfarin during pregnancy in women with mechanical heart valves, was shown to be associated with unacceptable high risk for the fetus. However, in the same group of women, judicious use of heparin during pregnancy was accompanied by a much reduced risk. The safety and adequate therapeutic range of heparin usage under such circumstances are subject to further studies.

• Journal of Chest Surgery
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• 제9권2호
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• pp.215-219
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• 1976

Anticoagulation therapy with Warfarin and Dipyridamole is useful after prosthetic heart valve replacement for the prevention of thromboembolic accidents. Here presented a case of right ovarian hematoma, 41 years old, female who has been already treated double valve replacement due to mitral insufficiency with 27 mm $Bj{\ddot{o}}rk-Shiley$ mitral, and 29 mm Hancock tricuspid valve successfully on 27th, April, 1976. Just after the operation, patient was treated the anticoagulation therapy with Dipyridamole 300 mg, and Heparin, and later switched to Warfarin 3.75 mg or 5 mg po, as the maintenance dose. Three and half months after the anticoagulation therapy, patient complained the lower abdominal pain and vaginal spotting and which revealed right ovarian hematoma due to ovulation, manifested due to anticoagulation therapy. Patient was discharged postoperative 15 th day with the maintenance dose 5 mg Warfarin and Dipyridamole 300mg po to maintain the prothrombin time 30%, after the uterus and both. ovaries and both adnexae are resected out for the prevention of the further hemorrhage of ovary.

• 한국임상약학회지
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• 제32권3호
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• pp.238-250
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• 2022

Objective: The aim of this study was to examine the impact of ATP-binding cassette subfamily B member 1 (ABCB1) C3435T polymorphism on the treatment response of patients to vitamin K antagonists (VKAs). Methods: In this systematic review and meta-analysis, the PubMed/Medline, Embase, and Cochrane Library databases were searched for eligible articles for the period up to November 2020. Articles that reported treatment response to VKAs according to the ABCB1 C3435T polymorphism were included in this study. Results: A total of 13 and 9 articles were included in the systematic review and meta-analysis, respectively. The weekly maintenance dose of warfarin was significantly lower in patients with the ABCB1 3435CT or TT polymorphism type than in those with the ABCB1 3435CC type (weighted mean difference [WMD], -2.53 mg/week; 95% confidence interval [CI], -3.64 to -1.43, p<0.001). However, the weekly maintenance dose of acenocoumarol was not significantly associated with the ABCB1 C3435T polymorphism (WMD, 1.02; 95% CI, -0.61 to 2.65, p=0.22). Conclusion: The ABCB1 C3435T polymorphism was significantly associated with the weekly maintenance dose of warfarin. Further research is needed to confirm the association between the ABCB1 C3435T polymorphism and the incidence rate of bleeding events.

• 대한임상독성학회지
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• 제7권2호
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• pp.164-171
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• 2009

Purpose: The number of patients who take warfarin is growing and so is the number of complications. Hemorrhage is the major complication, but the clinical characteristics and outcomes have not been determined for Korean patients. Therefore, we tried to evaluate the characteristics of the patients with hemorrhagic complications after taking warfarin as anticoagulation therapy. Methods: We retrospectively reviewed the medical records of the patients who visited the emergency room with bleeding complications after taking warfarin anticoagulation at the out-patient clinic for 1 year from 1 st January 2008. We compared between two groups (the major hemorrhage group vs. the minor hemorrhage group) according to the clinical criteria, the unstable vital signs that required blood transfusion, transfusion more than 2 units of blood, the need for further laboratory follow-up, the need for interventional treatment and the development of critical complications or death due to bleeding. Results: There were 150 patients who met the criteria and had acute hemorrhagic complications (the major group: 90 patients and the minor group: 60 patients). In the major hemorrhage group, the frequent sites of bleeding were the gastro-intestinal system (40 patients), lung (14 patients) and intracranium (7 patients). At the emergency room, the major group showed a higher initial INR of the activated prothrombin time than did the minor group (p=0.02). The bleeding sites of the fatal cases were the gastro-intestinal system (3 patients), lung (3 patients) and intracranium (3 patients), but the percentage of fatality was the highest for intracranium bleeding. Conclusion: In the major hemorrhage group, gastrointestinal bleeding was the most frequent complication and fatality was the highest for intracranium bleeding. An initially higher INR showed a greater risk of major bleeding, but not more fatalities.

• 대한한의학회지
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• 제19권1호
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• pp.179-204
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• 1998

The purpose of this research was to investigate the efficacy of Goiwhasan extract powder on the gastric injuries, antiulcer, gastrointestinal tract and blood hemostasis. Animals were used through this studies mice and rats. All animals were divided into 3 groups, contol group(no treatment), sample Ⅰ group(375mg/kg administration), sample Ⅱ group(750mg/kg administration). The gastric injuries and ulcer have been made by using pyloric ligation, indomethacin, HCI-ethanol, acetic acid and then The histological observation was followed. In the gastrointestinal tract, gastric juice secretion, gastric acidity, pepsin output, blood gastrin and secretin level, transport potentials in the small and large intestine were checked. And studies on blood hemostasis were performed on normal hemostatic activities and plasma prothrombin time, plasma recalcification time, plasma fibrinogen levels in the hypoprothrombinemic mice induced by warfarin. The results were as follows: 1. The antigastric ulcer effects on the pyloric ligation, indomethacin, HCl-ethanol, acetic acid induced gastric injuries were shown in Sample Ⅱ group(p<0.05). 2. Through the morphologic examination on the acetic acid induced ulcer, Sample Ⅰ group showed mild regeneration of epithelium and slight decrease of periulcer edema then that of Control group, while Sample Ⅱ group showed more retraction of round ulcer site, remarkable loss of swelling and edema then that of Control group, and revealing the regenerated epithelium in the surrounding ulcer site. Thus it was noted that both Sample groups have antigastriculcer effects on the experimentally induced gastric ulcer. 3. The inhibitory effects on gastric juice were noted in both Sample Ⅰ group(p<0.05) and Sample Ⅱ group(p<0.01). However, only Sample Ⅱ group showed the inhibitory effects on total acidity and pepsin output(p<0.05). 4. The significant inhibition of blood gastrin level showed at 30 min.(P<0.05) and 90 min.(P<0.05) after starting medication in only Sample Ⅱ group, but significance of blood secretin level in both groups was not recognized. 5. Any significant changes in barium sulfate transport in the small intestine of mice was not recognized in both groups, but the significantly inhibitory effect in large intestine was recognized in both Sample Ⅰ group(p<0.05) and Sample Ⅱ group(p<0.001). 6. In hemostatic effect on both normal mice and hypoprothrombinemic mice induced by warfarin, the significantly shortening effect on coagulation time was seen in only Sample Ⅱ group(p<0.01). 7. On plasma prothrombin time in hypoprothrombinemic rat induced by warfarin, Sample Ⅱ group have shortened the prothrombin time significantly(p<0.001). 8. On plasma reclcification time in hypoprothrombinemic rat induced by warfarin, the recalcification time have been shortened significantly in both Sample Ⅰ group(p<0.05) and Sample Ⅱ group(p<0.01). 9. On plasma fibrinogen levels in hypoprothrombinemic rat induced by warfarin, the fibrinogen contents in Sample Ⅱ have been decreased significantly(p<0.01). Overall the above results suggest that Goiwhasan has an therapeutic efficacy on antigastric ulcer and blood hemostasis. Further studies would be needed on the interaction of its herbal medicine and its mechanism in the future.