2017 年 43 巻 3 号 p. 161-168
Warfarin is a useful and effective oral anticoagulant. The management of the prothrombin time-international normalized ratio (PT-INR) is important for ensuring appropriate warfarin-based anticoagulation therapy. Here, we developed an anticoagulation management support (ACMS) system involving self-monitoring of the PT-INR and an Internet-based reporting system for outpatients. In the ACMS system, outpatients monitor their own PT-INR values using a CoaguChek® XS rapid measuring device and report the data to medical staff via a website. Then, the medical staff reply to the patients with information about their next dosage of warfarin based on the reported PT-INR data. We employed protocol-based pharmacotherapy management (PBPM), which was conducted by pharmacists, linked to the ACMS system to treat outpatients who received combination therapy involving warfarin and drugs that can have drug-drug interactions with warfarin, such as rifampicin, miconazole, 5-FU, and S-1. In the present study, we investigated the safety and efficacy of PBPM in 6 patients. There were no major discrepancies between the PT-INR values measured by self-monitoring and those obtained at hospital, and the patients did not make any errors when inputting their data via the website. By applying PBPM, anticoagulation therapy with warfarin was found to be safe and effective, and the time in therapeutic range was 82.1 ± 7.3％ (mean ± SD). No major adverse events, such as bleeding or embolisms, occurred in any patient during the observation period. These results suggest that PBPM linked to the ACMS has beneficial effects on warfarin-based anticoagulation therapy in outpatients.
