\uff1c\u6587\u732e\u540d\uff1e
\n\u3000Uptodate [Anticoagulation in acute pulmonary embolism]<\/p>\n
\uff1c\u3053\u306e\u6587\u732e\u3092\u9078\u3093\u3060\u80cc\u666f\uff1e
\n\u3000We
\nhave some patients in home visit who are difficult to do blood test. Because
\nthey have a fragile blood vessels and we can’t find thick and good ones. Some
\npatients take warfarin to prevent re-attack of pulmonary embolism, so we must
\ncheck INR every month.<\/p>\n
I\u2028wonder if it is necessary to check INR every month or it is possible to change\u2028a drug except warfarin or stop it.<\/p>\n
\uff1c\u8981\u7d04\uff1e Following discharge, initial monitoring can be reduced to once every few days until a stable dose has been achieved [40<\/a>] and then to once every four weeks [45<\/a>]. INR measurements should return to the more frequent interval any time that adjustments in the dose become necessary and the more frequent interval should be continued until a stable dose is again achieved. (See “Therapeutic use of warfarin<\/a>“. \u00a0\u958b\u50ac\u65e5\uff1a\u5e73\u621025\u5e745\u670822\u65e5<\/p>\n","protected":false},"excerpt":{"rendered":" \uff1c\u6587\u732e\u540d\uff1e \u3000Uptodate [Anticoagulation in acute pulmonary embolism] \uff1c\u3053\u306e\u6587\u732e\u3092\u9078\u3093\u3060\u80cc\u666f\uff1e \u3000We have some patients in home visi … \u7d9a\u304d\u3092\u8aad\u3080 \u5728\u5b85\u60a3\u8005\u306b\u304a\u3051\u308b\u80ba\u585e\u6813\u75c7\u306e\u518d\u767a\u4e88\u9632\u306e\u6cbb\u7642<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-279","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/279","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=279"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/279\/revisions"}],"predecessor-version":[{"id":280,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/279\/revisions\/280"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=279"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=279"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=279"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nMonitoring\u00a0—\u00a0The\u2028laboratory test most commonly used to measure the effects of warfarin is the INR. Warfarin therapy\u2028for acute PE should target an INR of 2.5 (range 2.0 to 3.0) [5,40<\/a>]. Randomized trials indicate\u2028that less intense anticoagulation (INR <2.0) is associated with an increased\u2028likelihood of recurrent PE or DVT and more intense anticoagulation is\u2028associated with bleeding [40-44<\/a>].<\/p>\n
\n\u00a0
\nLong-term therapy\u00a0—\u00a0After initial therapy with LMWH, UFH, or subcutaneous fondaparinux, long-term therapy is generally completed with a vitamin K antagonist, such as warfarin. Vitamin K antagonists are preferred over rivaroxaban due to the greater clinical experience with the former [5<\/a>].
\n\u00a0
\nDuration\u00a0—\u00a0We advocate the following treatment durations for warfarin therapy. Recommendations for indefinite therapy ascribe a higher value to preventing recurrent PE and a lower value to bleeding, cost, and inconvenience.
\n\u2022\u00a0\u00a0\u00a0 For patients with a first episode of acute PE due to a temporary risk factor (eg, surgery, immobilization, trauma), we recommend warfarin therapy for three months, rather than a shorter or longer duration (Grade 1B<\/a>). (See ‘Reversible risk factor’ above.)
\n\u2022\u00a0\u00a0\u00a0 For patients with a first episode of unprovoked acute PE, we recommend warfarin therapy for at least three months, rather than a shorter duration (Grade 1B<\/a>). The potential benefits and risks of indefinite anticoagulant therapy should be assessed after the three months of anticoagulant therapy (see ‘Unprovoked’ above):
\n\u2022\u00a0\u00a0\u00a0 For patients who have a low or moderate risk of bleeding, we suggest indefinite warfarin therapy, rather than three months of therapy (Grade 2B<\/a>).
\n\u2022\u00a0\u00a0\u00a0 For patients who have a high risk of bleeding, we recommend three months of warfarin therapy, rather than indefinite therapy (Grade 1B<\/a>).
\n\u00a0
\n\u2022\u00a0\u00a0\u00a0 For patients with two or more episodes of acute PE, we recommend warfarin therapy for at least three months, rather than a shorter duration (Grade 1B). The potential benefits and risks of indefinite anticoagulant therapy should be assessed after the three months of anticoagulant therapy (see ‘Recurrent PE’ above):
\n\u2022\u00a0\u00a0\u00a0 For patients who have a low risk of bleeding, we recommend indefinite warfarin therapy, rather than three months of therapy (Grade 1A<\/a>).
\n\u2022\u00a0\u00a0\u00a0 For patients who have a moderate risk of bleeding, we suggest indefinite warfarin therapy, rather than three months of therapy (Grade 2B<\/a>).
\n\u2022\u00a0\u00a0\u00a0 For patients who have a high risk of bleeding, we suggest three months of warfarin therapy, rather than indefinite therapy (Grade 2B<\/a>).
\nAnticoagulant therapy for\u2028patients with an acute PE who are pregnant or have a malignancy is discussed\u2028separately.<\/p>\n