Warfarin: what are the clinical implications of an out-of-range-therapeutic international normalized ratio?
Warfarin: what are the clinical implications of an out-of-range-therapeutic international normalized ratio?
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DOI：
10.1007/s11239-008-0219-9
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发表时间：
2009-04-01
影响因子：
4
通讯作者：
Tzanis, George
中科院分区：
文献类型：
--
作者：
Merli, Geno J.;Tzanis, George
华法林是一种常用的口服抗凝剂，临床疗效良好。然而，它的治疗窗口很窄，作用方式受个体间差异和环境因素的影响。华法林的有效性和安全性与维持国际标准化比值（INR）在治疗范围内密切相关。超治疗性INR使患者有出血的危险，而亚治疗性INR可能不能预防血栓栓塞并发症。研究表明，在不同的情况下，华法林治疗期间缺乏抗凝控制。仔细监测INR是必要的，特别是在大出血风险增加的老年人或癌症人群中。华法林是一种有效的治疗方法，但为了最大限度地提高疗效和安全性，优化风险-收益比至关重要。在这里，我们将评估INRs在华法林治疗管理中的问题程度，以及INRs可能对临床结果的影响。
Warfarin is a commonly used oral anticoagulant, and has well-established clinical efficacy. However, it has a narrow therapeutic window, and a mode-of-action affected by inter-individual differences and environmental factors. The effectiveness and safety of warfarin are closely related to maintenance of the international normalized ratio (INR) within therapeutic range. A supra-therapeutic INR puts patients at risk of bleeding, whereas a sub-therapeutic INR may not protect against thromboembolic complications. Research suggests a lack of anticoagulation control during warfarin therapy in different settings. Careful monitoring of the INR is essential, especially in geriatric or cancer populations who are at an increased risk of major hemorrhage. Warfarin is an effective treatment but optimization of the risk-benefit ratio is crucial in order to maximize efficacy and safety. Here, we will assess the extent to which INRs are an issue in the management of warfarin therapy, and the effect INRs may have on clinical outcomes.