Utjecaj interakcija lijekova na međunarodni normalizirani omjer (INR) u hospitaliziranih pacijenata na terapiji varfarinom

doctoral thesis

• Title (english): The influence of drug interactions on the international Normalized Ratio (INR) in hospitalized patients on warfarin therapy
• Author: Nives Gojo Tomić; MBZ: 37006002483
• Mentor: VELIMIR BOŽIKOV (mentor)
• Committee member: Vesna Bačić Vrca (predsjednik povjerenstva)
• Committee member: VELIMIR BOŽIKOV (član povjerenstva)
• Committee member: Igor Francetić (član povjerenstva); MBZ: 112991
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; Zagreb
• Defense date and country: 2012-07-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy
• Universal decimal classification (UDC): 615 - Pharmacology. Therapeutics. Toxicology

Abstract

Interakcije lijekova predstavljaju značajno područje istraživanja u suvremenoj
medicini. Varfarin kao temeljni lijek pri liječenju i prevenciji duboke venske tromboze,
plućne embolije i drugih bolesti, zbog svoje specifične građe, biotransformacije, metabolizma,
individualnog doziranja i opasnosti od krvarenja predstavlja trajni izazov.
U svrhu pokušaja evaluacije utjecaja interakcija lijekova na međunarodni
normalizirani omjer (INR) kao temeljni parametar praćenja terapije varfarinom, tijekom ovog
istraživanja je korišten računalni program za probir interakcija Lexi-Interact.
U radu je provedena analiza 339 bolesnika kojima je tijekom hospitalizacije
započeta terapija varfarinom, te su temeljem programa podijeljeni u ispitnu skupinu (223
bolesnika) sa mogućim klinički značajnim interakcijama s varfarinom i kontrolnu skupinu
(116 bolesnika) bez njih. Bolesnici su u prosjeku istodobno dobivali 5,28 lijekova (od
1-13 lijekova po bolesniku). Analizom rezultata vidljivo je da je 65,8% bolesnika bilo
izloženo klinički značajnim interakcijama (1-6 interakcija po bolesniku). Statistički
značajna razlika između navedene dvije skupine zabilježena je samo u broju lijekova,
izuzev varfarina, kojima su bolesnici bili liječeni. Interakcije nisu statistički značajno
utjecale na vrijednosti INR-a sedmog dana terapije, kao ni na visinu doze varfarina istog
dana. Značajan utjecaj interakcija nije zabilježen pri podjeli bolesnika na podskupine s
ciljnim INR između 2 i 3, te one iznad i ispod tih vrijednosti, kao niti na učestalost
zabilježenih nuspojava.
Zaključno, ovim istraživanjem nije dokazan utjecaj interakcija varfarina s drugim
lijekovima na međunarodni normalizirani omjer, te individualno titriranje i praćenje
ostaje temelj njegova uvođenja u terapiju.

Abstract (english)

Drug interactions represent an important area of research in modern medicine.
Warfarin, as the basic drug for treatment and prevention of deep venous thrombosis,
pulmonary embolism and other diseases, due to its specific composition, biotransformation,
metabolism, individual dosing and the risk of bleeding represents a permanent challenge.
In the attempt to evaluate the influence of drug interactions on the International
Normalized Ratio (INR), the computer program for screening drug interactions called Lexi-
Interact was used during this research as the basic parameter for monitoring warfarin
therapy.
In this paper, the analysis of 339 patients whose warfarin therapy began during
hospitalization was conducted. Based on the program, they were divided into the group
with (223 patients), and the group without (116 patients) possible clinically significant
interactions. On the average, the patients were concurrently taking 5.28 drugs (1-13 drugs per
patient). The analysis of results shows that 65.8% of patients were exposed to clinically
significant interactions (1-6 interactions per patient). Statistically significant difference
between the two groups was recorded only in the number of drugs, apart from warfarin,
the patients were treated with. The interactions did not have a statistically significant
impact on the INR values on the day 7 of therapy or on the dose of warfarin on the same day.
A significant influence of interactions was not recorded in the division of patients into
subgroups with target INR between 2 and 3, and those above and under those values; or
on the frequency of recorded side-effects.
In conclusion, this research did not prove the influence of warfarin interactions with
other drugs on the International Normalized Ratio, and therefore individual titration and
monitoring remains the basis of its introduction into therapy.

• Keywords: interakcije lijekova; varfarin; međunarodni normalizirani omjer; INR
• Keywords (english): drug interactions; warfarin; International Normalized Rratio; INR
• Language: croatian
• URN:NBN: urn:nbn:hr:163:697141
• Study programme: Title: Pharmacy and biochemistry; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor znanosti (doktor znanosti)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-12-01 12:52:05