Vanscoy G J, Coax W C
Department of Pharmacy and Therapeutics, University of Pittsburgh, PA, USA.
J Fam Pract. 1995 Sep;41(3):261-9.
For four decades, warfarin has been used extensively to treat thromboembolic disorders. Major advances in monitoring have been achieved through recognition of thromboplastin variability and implementation of the international normalized ratio (INR). Recommended INR ranges have shifted to lower intensity, and new clinical information has led to the potential for increased use of warfarin to prevent venous thromboembolism, to treat patients with prosthetic heart valves, to prevent stroke in patients with atrial fibrillation, and to prevent death and recurrent events after myocardial infarction. Optimal management of the patient who requires a drug that has a narrow therapeutic index, such as warfarin, remains challenging. Strategies to enhance patient outcomes with these drugs attempt to improve the risk-benefit ratio of such therapies, which requires optimizing the agent's effectiveness, improving its safety profile, or both.
四十年来，华法林一直被广泛用于治疗血栓栓塞性疾病。通过认识到凝血活酶的变异性并采用国际标准化比值（INR），监测方面取得了重大进展。推荐的INR范围已转向更低强度，新的临床信息使得华法林在预防静脉血栓栓塞、治疗人工心脏瓣膜患者、预防心房颤动患者中风以及预防心肌梗死后的死亡和复发事件方面的使用可能增加。对于需要使用治疗指数较窄的药物（如华法林）的患者，最佳管理仍然具有挑战性。使用这些药物提高患者治疗效果的策略试图改善此类治疗的风险效益比，这需要优化药物的有效性、改善其安全性，或两者兼顾。
