Warfarin Case Study

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1. INTRODUCTION
Warfarin is a most common Anticoagulant in prevention and treatment of thromboembolic events despite the availability of new drugs such as Novel Oral Anticoagulants due to its affordability. The establishment of the International Normalized Ratio (INR) helps to guide the dosing requirement for patients receiving the warfarin therapy. However, over-anticoagulation leads to adverse events such as haemorrhage while thromboembolic events can happen even at a recommended dose.
Different INR is based on different treatment. For example, for patients with atrial fibrillation, it is recommended that the INR range is 2.0-3.0, as the incidence of both haemorrhagic or thromboembolic events are the lowest. However, various studies have reported that Asian population are more sensitive to warfarin than Caucasian and African populations and a lower range of INR should be established. They have a higher risk of having intracranial haemorrhage and most Asian studies have also indicated that the Asians tend to have a higher risk of major bleeding
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This is to determine the optimal INR range with the lowest rate of thrombosis and bleeding events.
2. LITERATURE REVIEW
2.1 Anticoagulation therapy
2.11 Background
There is a growing number of patients on warfarin in Singapore. The statistics from Singapore General Hospital have indicated that the number of patients referred to the anticoagulation clinic has doubled to about 500 and about one-third of the 1,500 SGH patients who have been prescribed warfarin since 2001. The study also found that the percentage of time that patient’s international normalised ratio or INR readings stayed within target was from about 47 per cent to 66 per cent. The INR is a standard test to measure blood-clotting time. (SGH, 2012)

2.2 Coagulation
2.21 Thrombosis and

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