| ●原著 |
| Efficient dosage regimen for introduction of warfarin treatment after cardiovascular surgery in Japanese patients: comparisons between coronary artery bypass grafting and surgery for valvular heart disease |
Junichi Kawana,1‚2 Toshiya Koyanagi,3 Tetsuya Sumiyoshi,4
Kazuhiko Hanada,1 Tetsuo Ohno,2 and Hiroyasu Ogata1 |
1 Department of Biopharmaceutics & Clinical Pharmacokinetics, Meiji Pharmaceutical University
2 Department of Pharmacy
3 Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases
4 Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital |
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| We have demonstrated that the regimen in which warfarin was administered at 5 mg/day on the first day as the loading dose, at 3 mg/day from the 2nd day, and adjusted on the 7th day post coronary artery bypass grafting (CABG), was the most efficient and safe method for determining the optimal dose within 10 days of a procedure. In the present investigation, we extended this regimen to patients who had undergone cardiovascular surgery, including heart valve surgery. The percentage of patients achieving the optimal warfarin dose on the 9th day was 83.3% after CABG, but was as low as 47.4% after heart valve surgery. In the patients who had undergone heart valve surgery, we changed the regimen, such that the loading dose of warfarin was set at 5 mg/day on the first and second day. As a result, the percentage of patients achieving the optimal warfarin dose on the 9th day was 75% after CABG and 78.6% after heart valve surgery. In this regimen, the serious adverse events, such as major bleeding and thromboembolism, did not occur. We have demonstrated that the regimens were the most efficient and safe methods for determining the optimal dose within 10 days of a procedure, both in patients who had undergone CABG or heart valve surgery, by applying different methods for scheduled administration of warfarin. |
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| Keyword： warfarin, anticoagulant therapy, coronary artery bypass, heart valve replacement |
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