[포스터] 실제 임상에서 노인환자들의 비-비타민K 경구용 항응고제 사용 관찰 평가
2019년 추계학술대회 초록
- Sun-Hee Parko, Tae-Hwan Ima, Woo-Jung Choia, Eun-Ju Choib, Hye-Young Janga
Department of Pharmacy, Chosun University Hospitala, College of Pharmacy, Chosun Universityb
- Non-vitamin K antagonist oral anticoagulants (NOACs), Elderly Adults
[Purpose] The dose of Non-vitamin K antagonist oral anticoagulants (NOACs), which are used for the prevention of ischemic stroke caused by atrial fibrillation, must be determined in consideration of patient’s age and renal functions, and the use of NOACs requires periodic renal function monitoring. Further, because they are metabolized by CYP 3A4, anticoagulant effects may differ depending on drug interaction. In particular, the efficacy and adverse reactions of NOACs may be affected by old age, diminished renal function, and drug interaction due to the use of multiple drugs in the elderly. Thus, this study aims to assess the appropriateness of NOAC prescription and efficacy in elderly patients in clinical practice based on patients’ clinical state and concurrent medications.
[Methods] Elderly patients aged 65 years or older who were admitted to a tertiary university hospital for nonvalvular atrial fibrillation and has been administered NOACs (e.g. dabigatran, rivaroxaban, apixaban) for at least one week between January 2013 and December 2016 were enrolled in this study. Patients’ demographic background, appropriateness of prescription based on clinical state, and changes of biochemical and hematological parameters were retrospectively collected from medical records and analyzed.
[Results] The mean age of 137 participants (58 on dabigatran, 56 on rivaroxaban, and 23 on apixaban) was 79.6±6.7 years, and NOAC administration tended to be initiated with CrCl of 56.6±22.7 mL/min or higher and CHADS2-VAS score of 2 or higher (95.6%), and a bleeding risk of below 3 (83.9%). NOAC was administered without consideration of age and renal functions in 32.1% of the patients. The most common concurrently used drugs that interact with NOACs were diltiazem (7.3%) and amiodarone (8.0%). There were no significant differences in all clinical parameters examined (Scr, Aptt, AST, ALT, Hg), and only 18.2% of patients who have continuously taken NOACs were periodically monitored for clinical parameters while using the drug.
[Conclusion] When administering NOACs for the prevention of ischemic stroke in elderly patients with nonvalvular atrial fibrillation, an appropriate dose should be used in consideration of the patient’s clinical state and clinical parameters, and clinical parameters must be monitored continuously to examine the efficacy and adverse reactions to the drug.
- P-22. 박선희(조선대학교병원).pdf