Follow-Up of a Home Care Patient: Warfarin Usage

Öz

Warfarin is commonly used drug; however its dosage is affected by plenty of food and drugs. As it can cause bleeding, its follow-up is important. Patients are monitored by International Normalized Ratio (INR), standard value of the prothrombin time, and the target values vary 2-3.5 for different diagnosis.

A 76-year-old female patient had a cerebrovascular accident after a cholecystectomy operation. As a sequel she had loss of strength in her right foot. Her caregivers, 77-year-old husband and a professional caregiver, applied to home care services (HCSs).

Ecchymosis was seen in her body in her physical examination while vital signs were normal. Additionally decubitus ulcers on her gluteal region, loss of strength at her right foot was determined. She had been in this condition for 5-6 months and the ecchymosis was attributed to impacts during caring. She was referred to emergency department because of bleeding risk. In her first evaluation INR: 6.6, however no bleeding was not detected except for widespread ecchymosis. Warfarin was stopped for 3 days and the treatment regimen was planned again. After 12 days, control INR: 2.96. Family physicians' informing caregivers during follow-up of  home-care  patients,  about  patients'  drugs,  drug-drug  interactions,  especially drug-food interactions regularly is important.

Anahtar Kelimeler

• home care,warfarin,INR

Evde bakım hastasının izlemi: Varfarin kullanımı

Öz

Varfarin sık kullanılan ancak kullanım dozu pek çok ilaç ve yiyeceklerde etkilenen bir ilaçtır. Kanamaya neden olabileceğinden izlemi önemlidir. Hastalar Protrombin Zamanı standart değeri olan INR (International Normalized Ratio) ile izlenmekte ve farklı tanılarda hedef değerler 2-3,5 arasında değişmektedir.

76 yaşındaki kadın hasta kolesistektomi operasyonu sonrası serebrovasküler olay geçirmiştir. Hastanın sekel olarak sağ ayağında kuvvet kaybı mevcuttur. Hastaya bakan 77 yaşındaki eşi ve profesyonel bakıcısı evde sağlık hizmetleri (ESH) birimine başvurmuştur.

Vital bulguları normal olan hastanın vücudunda ekimozlar görüldü. Ayrıca gluteal bölgesinde bası yaraları, sağ ayakta kuvvet kaybı belirlendi. Hasta 5-6 aydır bu durumda ve morlukları bakım sırasındaki çarpmalara bağlanmış. Kanama riski nedeniyle acil servise sevk edildi. İlk değerlendirmesinde INR: 6,6 olup yaygın ekimoz dışında kanama tespit edilmedi. Varfarin üç gün kesildi ve tedavi rejimi yeniden düzenlendi. Oniki gün sonra bakılan kontrol INR: 2,96’ydi.

Aile hekimlerinin evde bakım hastalarının izlemlerinde bakımverenleri hastaların ilaçları, ilaç-ilaç etkileşimleri, özellikle ilaç-gıda etkileşimi konularında düzenli bilgilendirmesi önemlidir.

Anahtar Kelimeler

• evde bakım,varfarin,INR

Kaynakça

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