* Corresponding Author
EVALUASI DOSIS WARFARIN DAN HASIL TERAPINYA PADA PASIEN RAWAT JALAN
https://doi.org/10.22146/jmpf.284 Nova Hasani Furdiyanti(1*), I Dewa Putu Pramantara(2), Djoko Wahyono(3)
(1)
(2)
(3)
(*) Corresponding Author
Abstract
Penggunaan warfarin dimonitor berdasarkan efek farmakodinamik dari prothrombin time (PT) melalui nilai international normalized ratio (INR). Penelitian ini bertujuan untuk mengetahui perkiraan kadar warfarin dalam darah pasien, hasil terapi pasien yang mendapat terapi warfarin dilihat dari nilai INR, dan mengetahui korelasi antara perkiraan kadar warfarin dengan hasil terapi. Penelitian ini adalah penelitian observasional retrospektif yang bersifat deskriptif dan korelatif. Subjek penelitian adalah pasien rawat
jalan yang mendapat terapi warfarin oral di RSUP dr. Sardjito pada Jnuari 2011 sampai Oktober 2013. Perkiraan kadar warfarin dihitung berdasarkan rumus farmakokinetika, sedangkan analisis korelasi dilakukan dengan analisis korelatif Spearman. Hasil penelitian pada 86 subjek penelitian menunjukkan perkiraan kadar warfarin rata-rata pada keadaan tunak atau pada bulan ke-1 rata-rata sebesar 0,658 ± 0,315 mg/L, nilai rata-rata sebesar 0,135 ± 0,065 mg/L, dan nilai rata-rata sebesar 0,802 ± 0,384 mg/L. Hasil pemeriksaan INR menunjukkan 54 pasien (62,79%) yang rata-rata diberi warfarin dosis 2,15 ± 0,74 mg per hari, tidak mencapai target INR. Nilai INR yang dicapai rata-rata sebesar 1,29 ± 0,30, dengan jangkauan INR 0,90 – 1,93. Sisanya sebanyak 32 pasien (37,21%) yang rata-rata diberi warfarin dosis 2,41 ± 0,80 mg per hari, mencapai target INR rata-rata sebesar 3,10 ± 0,93, dengan jangkauan nilai INR 2,01 - 5,30. Korelasi antara perkiraan kadar warfarin dalam darah dengan nilai INR tidak bermakna dengan nilai p = 0,180 (p > 0,05), sedangkan nilai koefisien korelasi sebesar 0,146 menunjukkan arah korelasi positif dengan kekuatan korelasi yang sangat lemah.
Kata kunci: warfarin, kadar dalam darah, dosis, INR
Full Text:
UntitledReferences
Baglin, T.P., Cousins, D., Keeling, D.M., Perry, D.J., dan Watson, H.G., 2007, Safety Indicators for Inpatient and Outpatient Oral Anticoagulant Care: Recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency, British Journal of Haematology, 136 (1): 26–29.
Baker, R.I., Coughlin, P.B., Salem, H.H., Gallus, A.S., Harper, P.L., Wood, E.M., 2004, Warfarin Reversal: Consensus Guidelines, on Behalf of the Australasian Society of Thrombosis and Haemostasis. Medical Journal of Australia, 181(9): 492–497.
Clark, M.A., Finkel, R., Rey, J.A., Whalen, K., 2012, Lippincott’s Illustrated Reviews, Wolters Kluwer Health/Lippincott Williams & Wilkins, Baltimore.
Clarke, R., Ross, S., Walker, T., dan Woods, D., 2006, INR testing, Best Practice Advocacy Centre, Dunedin, New Zealand.
Dang, M.-T.N., Hambleton, J., dan Kayser, S.R., 2005, The Influence of Ethnicity on Warfarin Dosage Requirement, The Annals of pharmacotherapy, 39(6): 1008–1012.
Haines, S.T., Dowling, T., Harvey, R.D., 2006, Warfarin, in Burton, M.E., Applied Pharmacokinetics & Pharmacodynamics: Principles of Therapeutic Drug Monitoring. Lippincott Williams & Wilkins, Baltimore, 715–746.
Hirsh, J., Dalen, J., Anderson, D.R., Poller, L., Bussey, H., Ansell, J., et al., 2001, Oral Anticoagulants: Mechanism of Action, Clinical Effectiveness, and Optimal Therapeutic Range, CHEST Journal, 114(5): 445-469.
Holbrook, A., Schulman, S., Witt, D.M., Vandvik, P.O., Fish, J., Kovacs, M.J., et al., 2012, Evidence-based Management of Anticoagulant Therapy: Antithrombotic
Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, CHEST Journal, 141(2): e152S–84S.
Jaffer, A., dan Bragg, L., 2003, Practical Tips for Warfarin Dosing and Monitoring, Cleveland Clinic Journal of Medicine, 70(4): 361–371.
Rowland, M., dan Tozer, T.N., 2011, Clinical Pharmacokinetics and Pharmacodynamics: Concepts and Applications, 4th Ed. Wolters Kluwer Health/Lippincott William & Wilkins, Philadelphia.
Rusdiana, T., Araki, T., Nakamura, T., Subarnas, A., dan Yamamoto, K., 2013, Responsiveness to Low-Dose Warfarin Associated with Genetic Variants of VKORC1, CYP2C9, CYP2C19, and CYP4F2 in an Indonesian Population. European Journal of Clinical Pharmacology, 69(3): 395–405.
Sconce, E. A., Khan, T. I., Wynne, H. A., Avery, P., Monkhouse, L., King, B. P., & Kamali, F., 2005, The impact of CYP2C9 and VKORC1 Genetic Polymorphism and Patient Characteristics Upon Warfarin Dose Requirements: Proposal for a New Dosing Regimen, Blood, 106(7): 2329-2333.
Sun, S., Wang, M., Su, L., Li, J., Li, H., Gu, D., 2006, Study on Warfarin Plasma Concentration and Its Correlation with International Normalized Ratio, Journal of Pharmaceutical and Biomedical Analysis, 42(2): 218–222.
Usman, E., 2007, Pemakaian Obat dengan Margin of Safety yang Sempit Seharusnya Memerlukan Therapy Drug Monitoring (TDM), Majalah Kedokteran Andalas, 31(2): 1–6.
Wallace, J.L., Reaves, A.B., Tolley, E.A., Oliphant, C.S., Hutchison, L., Alabdan, N.A., et al., 2013, Comparison of Initial Warfarin Response in Obese Patients Versus NonObese Patients, Journal of thrombosis and thrombolysis, 36: 96–101.
DOI: https://doi.org/10.22146/jmpf.284
Article Metrics
Abstract views : 3233
| 
views : 34657
Refbacks
- There are currently no refbacks.
Copyright (c) 2014 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
