The anticoagulant drug warfarin is used to prevent conditions such as venous thrombosis and so on. Since warfarin has many interactions with other drugs and a large inter-individual pharmacodynamic variability, its dosage must be adjusted based on the prothrombin time international normalized ratio (PT-INR) in each patient. Oxycodone is often used to control cancer pain. In the drug package insert, care should be taken when co-administering oxycodone with warfarin, but the mechanism of the interaction between the two remains unknown. In addition, there have been no reports on interaction between oxycodone and warfarin in patients. In this study, we retrospectively investigated the effect of oxycodone on the blood coagulation activity in 9 cancer patients who were treated with warfarin. After combination with oxycodone, the total dosage of warfarin in two weeks was significantly decreased to 78.6% of that without oxycodone. The median of PT-INR was also significantly increased from 2.03 to 2.30 compared to that without oxycodone. Moreover, the median of the warfarin sensitivity index, which was defined as PT-INR/warfarin dose (mg/day), was also significantly increased from 0.78 to 0.96 after coadministration with oxycodone. These results suggest that the anticoagulant effect of warfarin was increased after the co-administration of oxycodone in cancer patients treated with warfarin. Therefore, PT-INR should be frequently monitored after the start of coadministration of oxycodone.
Compared with the increase of cancer patients, there is insufficiency number of beds at palliative care unit(abbreviated to PCU)and hospice. To utilize them as medical resource efficiently, it is necessary to assess the condition of patients and to decide the order of admission fairly and impartially. The appropriate way of decision is also a prerequisite of the facility criterion of hospice by the Ministry of Health, Labour and Welfare and one of the evaluation items of palliative care by Japan Council for Quality Health Care. Many PCUs and hospices declare that a conference for the hospitalization judgment is held regularly, although few hospitals disclose the process of decision and its criteria of the order of priority. We made a checklist for the judgment of hospice admission in which the needs of hospitalization are converted to the numerical value in terms of patient's willingness, condition, context and prognosis. The checklist was introduced in our PCU in September 2012. In 2013 fiscal year, the conference for the judgment of PCU admission was held almost once a week(51 times)and the total number discussed were 403 cases(7.9 cases per one conference)and those who were actually hospitalized were 187 patients. The imbalance shows the necessity of the fair and impartial decision.
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