The incidence, magnitude, and time course of the amiodarone-warfarin interaction.
The incidence, magnitude, and time course of the amiodarone-warfarin interaction.
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DOI：
10.1001/archinte.1988.00380080065018
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发表时间：
1988-08
影响因子：
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通讯作者：
N. Kerin;R. Blevins;L. Goldman;K. Faitel;M. Rubenfire
中科院分区：
文献类型：
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作者：
N. Kerin;R. Blevins;L. Goldman;K. Faitel;M. Rubenfire
对8例同时使用胺碘酮和华法林钠治疗的患者进行了研究，以确定这些药物之间的相互作用。所有患者均满足以下标准：(1)基线稳定的治疗性凝血酶原时间（PT），定义为在开始胺碘酮治疗前两周内至少连续两次获得PT，且变化小于或等于15%；(2)在胺碘酮治疗前2周未调整华法林剂量；（三）未使用其他影响凝血研究结果的药物；(4)开始胺碘酮治疗后1、2、4、8周的随访PTs。PT的临床显著变化定义为大于15%。接受5.99 mg/d华法林钠治疗的患者平均基线PT为19.8 s。患者的PT平均最大增加44%（范围，22%至108%），发生在前两周。在6例患者中，PT在第4周或第8周恢复到基线的15%以内，每日华法林需用量下降了35%（范围为25%至50%）。尽管华法林剂量减少了33%，但两例患者在第8周时的PTs与基线相比变化大于15%。在这个系列中没有患者遇到抗凝治疗的并发症，可能是由于早期发现和剂量减少。虽然机制尚不清楚，但我们的研究表明，胺碘酮增强华法林的作用发生在所有患者中，发生在胺碘酮治疗的前两周，不同程度地增加了22%至108%的PT，降低了25%至50%的华法林需求。我们建议预防性减少25%的华法林剂量，并在开始胺碘酮治疗后的一个月内每周测量一次PT。
Eight patients concurrently treated with amiodarone and warfarin sodium were studied to characterize the interaction between these drugs. All fulfilled the following criteria: (1) stable and therapeutic prothrombin time (PT) at baseline, defined as at least two consecutive PTs obtained within two weeks before beginning amiodarone therapy that varied by less than or equal to 15%; (2) no warfarin dosage adjustment in the two weeks prior to amiodarone therapy; (3) no other drugs given that alter coagulation study results; and (4) follow-up PTs obtained 1, 2, 4, and 8 weeks after initiation of amiodarone treatment. A clinically significant change in PT was defined as greater than 15%. Mean baseline PT was 19.8 s for patients receiving 5.99 mg/d of warfarin sodium. Patients had a mean maximum increase in PT of 44% (range, 22% to 108%), which occurred during the first two weeks. In six patients, the PT returned to within 15% of baseline by week 4 or 8, and the daily warfarin requirement had decreased by 35% (range, 25% to 50%). Two patients had PTs varying by greater than 15% from baseline at week 8 despite a 33% reduction in warfarin dosage in each case. No patient in this series encountered complications of anticoagulant therapy, perhaps due to early recognition and dosage reduction. Although the mechanism remains unclear, our study indicates that amiodarone potentiation of warfarin effects occurs in all patients, occurs in the first two weeks of amiodarone therapy, variably increases PT by 22% to 108%, and lowers the warfarin requirement by 25% to 50%. We recommend a 25% prophylactic reduction of warfarin dosage and weekly measurements of PT for one month when amiodarone therapy is initiated.