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All Journal JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Subakti Zulkarnain, Bambang
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Chemistry Education Health Professions Medicine & Pharmacology Other

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Exploring Side Effects of Warfarin in Outpatients at Tertiary Hospital in Indonesia Zahra Oviary Satryo, Fatimatuz; Wahyuni, Dewi; Suprapti, Budi; Putri Nilamsari, Wenny; Yusuf Alsagaff, Mochamad; Makmuroh Nurul Qomar Purnamawati, Dewi; Subakti Zulkarnain, Bambang
JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA Vol. 12 No. 2 (2025): JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jfiki.v12i22025.142-150

Abstract

Background: Patients with atrial fibrillation, venous thromboembolism, valvular disease, cardioembolic stroke, and acute myocardial infarction are prescribed the oral anticoagulant warfarin to treat thrombi. To guarantee its efficacy and safety, anticoagulants must be closely monitored. Furthermore, warfarin has a narrow therapeutic index, which increases the risk of side effects, particularly in the early stages of treatment. Objective: This study aimed to analyze the incidence of warfarin side effects in outpatients at Dr. Soetomo General Hospital. Methods: A retrospective cross-sectional design was adopted for outpatients at the Cardiology Department of Dr. Soetomo General Hospital from March to May 2023. Data were collected on the incidence of side effects in outpatients who received warfarin for a minimum of one month through an interview process. Other data, including age, sex, duration of warfarin therapy, comorbidities, and INR at the last scan, were extracted from medical records. The Chi-Square test was used to examine the data. Results: The results showed that 88 patients (42.7%) had side effects of bleeding (126 events). These included gum bleeding (22.3%), hematoma (20.4%), melena (7.7%), menometrorrhagia (2.4%), epistaxis (1.9%), hematuria (1.5%), hematemesis (1.0%), hemoptysis (1.0%), spontaneous venous bleeding  (1.0%), hematochezia (0.5%), hemostasis during blood sampling  (0.5%), tongue bleeding  (0.5%), and subconjunctival bleeding  (0.5%). Conclusion: The incidence of side effects during warfarin treatment was high, accounting for approximately 42.7% of cases. Furthermore, one patient experienced more than one side effect.
Efficacy of Ticagrelor Monotherapy in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: a Systematic Review Nur Arifana, Erlita; Subakti Zulkarnain, Bambang
JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA Vol. 12 No. 2 (2025): JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jfiki.v12i22025.174-194

Abstract

Background: Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) prevents ischemic events. However, prolonged therapy increases the risk of bleeding. In this context, an antithrombotic strategy is applied to post-PCI patients by discontinuing aspirin and maintaining P2Y12 receptor monotherapy. Currently, patients with ACS treated with the single antiplatelet agent ticagrelor prefer to apply DAPT for 1 to a few months to open blocked arteries. Objectives: This systematic review aimed to evaluate the clinical efficacy of transitioning high-bleeding-risk patients to ticagrelor monotherapy following a three-month course of DAPT. Methods: A systematic literature review based on the PRISMA statement was conducted to review articles on DAPT, PCI, ticagrelor monotherapy, and high bleeding risk (HBR). The article search was conducted using Internet search databases, including PubMed and ScienceDirect, published between January 2014 and December 2024. Results: Six studies met the inclusion criteria and were included in the analysis. Clinical outcomes were assessed over a follow-up period of up to one year, including endpoints such as all-cause mortality, myocardial infarction, stent thrombosis, stroke, and target vessel revascularization. The secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), significant bleeding defined by Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and net adverse clinical events (NACE). Conclusion: the use of ticagrelor monotherapy after 3 months of dual antiplatelet therapy is expected to assist healthcare professionals in considering the risk-benefit of single therapy for patients after percutaneous coronary intervention.
Co-Authors Budi Suprapti Makmuroh Nurul Qomar Purnamawati, Dewi Nur Arifana, Erlita Putri Nilamsari, Wenny Raden Mohamad Herdian Bhakti Yusuf Alsagaff, Mochamad Zahra Oviary Satryo, Fatimatuz