Exaggerated initial response to <i>warfarin</i> following heart valve replacement

作     者：Ageno, W Turpie, AGG 

作者机构：Hamilton Hlth Sci Corp Gen Div Hamilton ON L8L 2X2 Canada 

出 版 物：《AMERICAN JOURNAL OF CARDIOLOGY》 (美国心脏病学杂志)

年 卷 期：1999年第84卷第8期

页      面：905-908页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：抗凝药/投药和剂量 抗凝药/治疗应用 病例对照研究 卡方分布 剂量效应关系 药物 心脏瓣膜假体植入 国际标准化比 回顾性研究 血清白蛋白/代谢 华法林/投药和剂量 华法林/治疗应用 老年人 女(雌)性 人类 男(雄)性 中年人 

摘      要：The response to initiation of oral anticoagulants at a usual dose of 5 mg of warfarin has been retrospectively evaluated in patients following heart valve replacement (HVR), Patients starting oral anticoagulants after HVR have a lower target International Normalized Ratio (INR) (1.5 to 2.6) until the pacing wires are removed after operation. The mean daily doses and INR responses after HVR and nonsurgical patients were retrospectively compared during the first 5 days of warfarin treatment. In a subset from both groups, the mean dose of warfarin was correlated with age, body weight, and albumin levels. Eighty-four HVR and 32 nonsurgical patients were studied. The mean daily warfarin dosage was 3.29 +/- 1.29 mg after HVR and 4.96 +/- 1.76 mg in controls (p 0.001), and the mean INRs 2.08 +/- 0.60 and 1.60 +/- 0.54, respectively (p 0.001), Of the HVR patients and controls, 48.8% and 21.8%, respectively, exceeded the upper level of the targeted range (p = 0.014), 86.9% and 40.6% had the dose reduced after the first 5 mg (p 0.001), and 54.7% and 28.1%, respectively, had warfarin withheld for at least 1 day(p = 0.015). Thirty-nine patients were included in the subset analysis. Patients with serum albumin levels 35 g/L required significantly less warfarin (3.84 mg/day) than patients with levels greater than or equal to 35 g/L (5.37 mg/day;p 0.05). Thus, patients starting oral anticoagulation after HVR are significantly more sensitive to warfarin than nonsurgical patients, Patients with serum albumin levels below the normal values require less warfarin than patients with normal values during the initial phase of treatment, (C) 1999 by Excerpta Medica, Inc.