Pulmonary-heart Center of Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Pulmonary-heart Center of Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Heart Lung. 2014 Jul-Aug;43(4):358-62. doi: 10.1016/j.hrtlng.2014.04.005. Epub 2014 May 10.
The concomitant prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) and pulmonary embolism (PE) is strikingly high, and therefore we studied the patients with PE to determine whether those who had OSHAS required greater warfarin doses to achieve a therapeutic international normalized ratio (INR).
By using computer tomographic pulmonary angiography or pulmonary angiography, we identified and recruited 97 patients with PE and all underwent polysomnography. Warfarin was initiated at a dose of 3 mg/day and modified to adjust the INR to the range of 2.0-3.0.
OSAHS patients (n = 32) required a significantly higher dose of warfarin than their non-OSAHS counterparts (5.01 mg vs 3.61 mg, P < .001). This difference still existed between the two groups after adjusting for covariates (achieved INR value and weight). Logistic analysis suggested that OSAHS was an independent risk factor for high dose warfarin (OR 5.715, P < .001). On admission, OSAHS patients had a lower mean value of INR and prothrombin time but higher plasminogen (PLG) activity compared to non-OSAHS patients. Other coagulation indices were not significantly different between the two groups. Except for the PLG activity (r = .273, P = .026), the correlation between the warfarin dose and the baseline coagulating indices wasn't significant.
Our findings indicate that factors associated with OSAHS, such as hypercoagulation, may explain the need for higher doses of warfarin in treating patients with PE.
阻塞性睡眠呼吸暂停低通气综合征（OSAHS）和肺栓塞（PE）同时存在的发生率非常高，因此我们研究了 PE 患者，以确定是否 OSHAS 患者需要更高的华法林剂量来达到治疗国际标准化比值（INR）。
通过计算机断层扫描肺动脉造影或肺动脉造影，我们确定并招募了 97 例 PE 患者，所有患者均接受了多导睡眠图检查。华法林起始剂量为 3 毫克/天，并调整剂量以将 INR 调整至 2.0-3.0 范围。
OSAHS 患者（n=32）需要的华法林剂量明显高于非 OSAHS 患者（5.01 毫克对 3.61 毫克，P<0.001）。在校正协变量（INR 值和体重）后，两组之间仍存在差异。Logistic 分析表明，OSAHS 是高剂量华法林的独立危险因素（OR 5.715，P<0.001）。入院时，与非 OSAHS 患者相比，OSAHS 患者的 INR 和凝血酶原时间的平均值较低，但纤溶酶原（PLG）活性较高。两组其他凝血指标无显著差异。除 PLG 活性（r=.273，P=.026）外，华法林剂量与基线凝血指标之间无显著相关性。
我们的研究结果表明，与 OSAHS 相关的因素，如高凝状态，可能解释了治疗 PE 患者时需要更高剂量华法林的原因。
