Analysis of factors for international normalized ratio levels>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Shengmin ^1,2 , FU Bo ³ , ZHANG Fengying ⁴ , MA Weijie ² , HUANG Shourui ⁵ , LI Qian ⁶ , TAO Huan ⁷ , DONG Li ¹ ,  CHEN Jin ^1,2 , ZHAO Shengmin ^1,2 , FU Bo ³ , ZHANG Fengying ⁴ , MA Weijie ² , HUANG Shourui ⁵ , LI Qian ⁶ , TAO Huan ⁷ , DONG Li ¹ ,  CHEN Jin ^1,2

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Clinical Epidemiology and Evidence-based Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;
4. Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041, P. R. China;
5. West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, P. R. China;
6. Department of Radiology, West China hospital, Sichuan University, Chengdu, 610041, P. R. China;
7. Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

CHEN Jin, Email: ebm_chenjin@126.com; CHEN Jin, Email: ebm_chenjin@126.com

Keywords：

Mechanical heart valve replacement; warfarin; anticoagulation therapy; international normalized ratio

DOI：

10.7507/1007-4848.202402023

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Objective To investigate the factors influencing international normalized ratio (INR) levels>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Methods A retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. The factors associated with INR levels>3.0 at the time of discharge were analyzed. Results A total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. Multivariate logistic regression analysis revealed that lower body mass index (BMI), preoperative prothrombin time (PT)>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge(P<0.05). Conclusion BMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.

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1. 高润霖. 中国心瓣膜病现状. 华西医学, 2018, 33(2): 127-131.
2. 高润霖. 中国心瓣膜病现状. 华西医学, 2018, 33(2): 127-131.
3. 中华医学会胸心血管外科分会瓣膜病外科学组. 心脏瓣膜外科人工瓣膜选择中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 138-145.
4. 中华医学会胸心血管外科分会瓣膜病外科学组. 心脏瓣膜外科人工瓣膜选择中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 138-145.
5. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
6. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
7. Klein TE, Altman RB, et al. Estimation of the warfarin dose with clinical and pharmacogenetic data. N Engl J Med, 2009, 360(8): 753-764.
8. International Warfarin Pharmacogenetics Consortium, Klein TE, Altman RB, et al. Estimation of the warfarin dose with clinical and pharmacogenetic data. N Engl J Med, 2009, 360(8): 753-764.
9. Bourgeois S, Jorgensen A, Zhang EJ, et al. A multi-factorial analysis of response to warfarin in a UK prospective cohort. Genome Med, 2016, 8(1): 2.
10. Bourgeois S, Jorgensen A, Zhang EJ, et al. A multi-factorial analysis of response to warfarin in a UK prospective cohort. Genome Med, 2016, 8(1): 2.
11. Spina E, Barbieri MA, Cicala G, et al. Clinically relevant drug interactions between newer antidepressants and oral anticoagulants. Expert Opin Drug Metab Toxicol, 2020, 16(1): 31-44.
12. Spina E, Barbieri MA, Cicala G, et al. Clinically relevant drug interactions between newer antidepressants and oral anticoagulants. Expert Opin Drug Metab Toxicol, 2020, 16(1): 31-44.
13. Wang M, Zeraatkar D, Obeda M, et al. Drug-drug interactions with warfarin: A systematic review and meta-analysis. Br J Clin Pharmacol, 2021, 87(11): 4051-4100.
14. Wang M, Zeraatkar D, Obeda M, et al. Drug-drug interactions with warfarin: A systematic review and meta-analysis. Br J Clin Pharmacol, 2021, 87(11): 4051-4100.
15. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: A prevalent adverse effect resulting in regulatory action. Arch Intern Med, 2007, 167(13): 1414-1419.
16. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: A prevalent adverse effect resulting in regulatory action. Arch Intern Med, 2007, 167(13): 1414-1419.
17. Loebstein R, Yonath H, Peleg D, et al. Interindividual variability in sensitivity to warfarin: Nature or nurture? Clin Pharmacol Ther, 2001, 70(2): 159-164.
18. Loebstein R, Yonath H, Peleg D, et al. Interindividual variability in sensitivity to warfarin: Nature or nurture? Clin Pharmacol Ther, 2001, 70(2): 159-164.
19. 潘华英, 罗玲玲, 杨梦娇, 等. 心脏机械瓣膜置换术后华法林抗凝治疗出血并发症的研究进展. 全科护理, 2022, 20(2): 191-195.
20. 潘华英, 罗玲玲, 杨梦娇, 等. 心脏机械瓣膜置换术后华法林抗凝治疗出血并发症的研究进展. 全科护理, 2022, 20(2): 191-195.
21. 中华医学会心血管病学分会, 中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 2013, 52(1): 76-82.
22. 中华医学会心血管病学分会, 中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 2013, 52(1): 76-82.
23. Cheng TO. Chinese patients require lower dosage of warfarin. Int J Cardiol, 2010, 139(1): 1.
24. Cheng TO. Chinese patients require lower dosage of warfarin. Int J Cardiol, 2010, 139(1): 1.
25. Zhou XM, Zhuang W, Hu JG, et al. Low-dose anticoagulation in Chinese patients with mechanical heart valves. Asian Cardiovasc Thorac Ann, 2005, 13(4): 341-344.
26. Zhou XM, Zhuang W, Hu JG, et al. Low-dose anticoagulation in Chinese patients with mechanical heart valves. Asian Cardiovasc Thorac Ann, 2005, 13(4): 341-344.
27. Cheung YF, Leung MP. Low dose oral anticoagulation therapy in Chinese children with congenital heart disease. J Paediatr Child Health, 1998, 34(6): 563-567.
28. Cheung YF, Leung MP. Low dose oral anticoagulation therapy in Chinese children with congenital heart disease. J Paediatr Child Health, 1998, 34(6): 563-567.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesAnalysis of factors for international normalized ratio levels>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement

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