心力衰竭恶化对抗凝的影响：一项前瞻性、观察性、试点队列研究。

Effect of heart failure exacerbations on anticoagulation: a prospective, observational, pilot cohort study.

机构信息

Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma 73126, USA.

出版信息

Clin Ther. 2010 Mar;32(3):506-14. doi: 10.1016/j.clinthera.2010.03.001.

DOI:10.1016/j.clinthera.2010.03.001

PMID:20399987

Abstract

BACKGROUND

Some studies have suggested that heart failure (HF) is associated with excessive anticoagulation, but definitive data or data showing causation do not exist. Knowledge of risk factors for excessive anticoagulation is critical to manage warfarin therapy safely.

OBJECTIVE

This study characterized the relation between HF-associated hypervolemia and excessive anticoagulation in patients with HF taking chronic warfarin therapy.

METHODS

This was a prospective, observational pilot study conducted in a university-based HF clinic. Patients aged 18 to 85 years with HF and taking warfarin were enrolled and were observed for episodes of hypervolemia. Hypervolemia was determined based on multiple clinical factors, including patient-reported symptoms and physical examination. Anticoagulation was assessed longitudinally per standard of care by measurement of the international normalized ratio (INR). A chi(2) analysis was used to determine whether hypervolemia was associated with an increased risk of excessive anticoagulation. Paired and unpaired t tests were used for ad hoc analyses.

RESULTS

Forty patients with 41 HF episodes who were taking warfarin were enrolled between December 2003 and July 2007. Mean (SD) age was 67.2 (11.1) years and mean weight was 218.5 (62.8) pounds; 29 patients (72.5%) were men and 34 (85.0%) were white. Most had systolic dysfunction (n = 26; 65.0%) and were taking warfarin for atrial fibrillation (n = 33; 82.5%); the mean weekly warfarin dose was 30.8 (17.5) mg. There were 41 evaluable hypervolemia episodes over a mean follow-up of 14.5 (9.0) months. The mean INR change during hypervolemia was -0.02 (0.82) INR unit (P = NS vs baseline). No association was found between hypervolemia episodes and INR increases of > or =50% (P = NS); the results remained nonsignificant for both diastolic and systolic HF when analyzed separately. There was no significant change from baseline INR between patients classified with mild, moderate, or severe hypervolemia or between patients classified according to New York Heart Association (NYHA) functional class (all, P = NS). Patients with NYHA class III had a lower weekly warfarin dose than those with NYHA class II (25.73 vs 31.75 mg; P < 0.01).

CONCLUSION

Mild hypervolemia did not appear to be related to excessive anticoagulation in these patients with HF taking chronic warfarin therapy.

摘要

背景

一些研究表明心力衰竭（HF）与过度抗凝有关，但尚无明确数据或表明因果关系的数据。了解过度抗凝的危险因素对于安全管理华法林治疗至关重要。

目的

本研究旨在描述 HF 相关血容量过多与服用慢性华法林治疗的 HF 患者过度抗凝之间的关系。

方法

这是一项在大学 HF 诊所进行的前瞻性、观察性试点研究。纳入年龄在 18 至 85 岁之间、患有 HF 并服用华法林的患者，并观察其血容量过多的发作情况。血容量过多是基于包括患者报告的症状和体格检查在内的多种临床因素确定的。抗凝情况通过测量国际标准化比值（INR）按标准护理进行纵向评估。卡方分析用于确定血容量过多是否与过度抗凝的风险增加相关。配对和非配对 t 检验用于特殊分析。

结果

2003 年 12 月至 2007 年 7 月期间，共纳入 40 例接受华法林治疗的 HF 患者（共 41 例 HF 发作）。平均（SD）年龄为 67.2（11.1）岁，平均体重为 218.5（62.8）磅；29 名患者（72.5%）为男性，34 名（85.0%）为白人。大多数患者有收缩功能障碍（n=26；65.0%），并因心房颤动而服用华法林（n=33；82.5%）；每周华法林剂量平均为 30.8（17.5）mg。在平均 14.5（9.0）个月的随访期间，共发生 41 次可评估的血容量过多发作。血容量过多期间 INR 的平均变化为-0.02（0.82）INR 单位（P=NS 与基线相比）。在分析舒张和收缩 HF 时，血容量过多发作与 INR 增加>或=50%之间均未发现关联（P=NS）；两者均无显著意义。根据纽约心脏协会（NYHA）功能分类轻度、中度或重度血容量过多患者之间，以及根据 NYHA 功能分类患者之间，INR 从基线无显著变化（均 P=NS）。NYHA 心功能 III 级患者的华法林剂量低于 NYHA 心功能 II 级患者（25.73 与 31.75 mg；P<0.01）。