Warfarin為抗凝血劑，主要用於罹患心血管疾病之病患，該藥物與一些藥物和疾病有很強的交互作用，容易受到外在因素而加強或削弱其藥效，因此使用時需特別小心，若warfarin劑量不足，則病患易發生血管拴塞；劑量過多將會導致病患有出血的風險。目前國內warfarin的建議劑量皆參考歐美之用藥指南，而國內對於warfarin劑量研究不多，也尚未出現以華人病歷資料為基礎之用藥參考的相關研究，因此本研究將採用某大型醫院於一段期間內開方使用warfarin的病歷資料，針對華人進行warfarin使用劑量之探討。

該筆資料共有87位病患，其中女性病患45位，男性病患42位，以每位病患拿到warfarin的處方計為一個人次，共計415人次，資料內容包含年齡、INR值、影響處方的藥物與疾病等，由於該病例屬於重複觀測型之資料，因此本研究將採用廣義估計方程式，評估藥物warfarin在不同影響因子下的使用劑量。

本研究利用廣義估計方程式分析藥物warfarin在不同影響因子下的使用劑量，得到以下結果：(一) 藥物warfarin的平均使用劑量會因為病人罹患病原不明之肺炎、充血性心臟衰竭、非酒精引起的肝硬化、急性腎衰竭與其他革蘭氏陰性細菌所致之肺炎等疾病而降低至少0.1毫克的使用劑量。(二) 與warfarin共同使用時需要特別考慮的藥物，至少都對warfarin平均使用劑量產生0.1毫克的增減。(三) 在其他影響因子不變之下，當INR值增加1單位，warfarin平均使用劑量約需增加0.27至0.28毫克。

Warfarin is the anti-coagulation and it is irreplaceable. Warfarin dose is affected by many factors, such as related drugs and diseases. Using warfarin has to be careful. If patients take inadequate doses, they will be blood clots. On the other hand, if patients take excessive doses, they will be bleeding. Currently, we refer to warfarin-used guide for Europeans and Americans in Taiwan, and there are few domestic papers about warfarin dose. In addition, it has not published a study of warfarin dose which is based on Chinese case history. Therefore, this research in warfarin dose is based on case history of patints who used warfarin in a perid in a large hospital.

This data is composed of 87 patints, including 45 females and 42 males. Each patient getting warfarin prescription is counted as one sample, and the data amounts to 415 samples comprisig age, INR, related drugs and related diseases. Thence, it is a repeat measurement data, so using generalized estimating equations (GEE) to estimate warfarin dose in each case.

The GEE results are found that (1) all related diseases we selected reduced dose about 0.1mg, (2) related drugs bring about 0.1mg of adjustment in dose at least. (3)As other conditions remain unchanged, the INR rise 1 degree, the average of warfarin dose takes more about 0.27mg - 0.28mg.

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與待答問題 3
第三節 名詞釋義 4
第四節 研究範圍與限制 6
第二章 文獻探討 9
第一節 介紹抗凝血劑warfarin 9
第二節 國內warfarin研究 13
第三章 研究方法 17
第一節 資料分析 17
第二節 分析方法 28
第四章 研究結果 31
第一節 所有影響因子之GEE配適 31
第二節 具影響力的影響因子之精簡GEE配適 33
第三節 臨床需要之GEE配適 35
第五章 研究結論與討論 37
第一節 研究結論 37
第二節 研究討論 38
參考文獻 39
附錄 43

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