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与华法林敏感性相关的临床预测因素。

Clinical Predictors Associated With Warfarin Sensitivity.

作者信息

Saleh Mohammad I

机构信息

Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan.

出版信息

Am J Ther. 2016 Nov/Dec;23(6):e1690-e1694. doi: 10.1097/MJT.0000000000000248.

Abstract

Our study aimed to identify predictors of warfarin sensitivity like demographic, clinical, and genetic data from a previously collected cohort of patients (n = 4272) with a stable warfarin dose who were able to achieve an observed international normalized ratio of 2-3. Predictors of warfarin sensitivity (dose ≤21 mg/wk) were identified using a 2-stage approach. First, bivariate analysis, using analysis of variance for continuous variables and χ test for categorical variables, was performed to identify possible predictors of warfarin sensitivity (P < 0.05). Second, logistic regression with backward stepwise selection was then performed using predictors identified in bivariate analysis step to produce final model containing independent predictors at P < 0.05. Increased warfarin sensitivity was associated with increased age; CYP2C9 genotypes 2/3, 1/3, and 3/3; VKORC1 genotypes AA and AG; and amiodarone use. Decreased warfarin sensitivity (ie, weekly warfarin dose of >21 mg) was associated with increased height, increased weight, having diabetes mellitus, VKORC1 genotype GG, and CYP2C9 genotype 1/1. In conclusion, we identified patients' characteristics associated with warfarin sensitivity. This project is expected to improve patient care by identifying patients who need a low warfarin dose before warfarin administration. Early identification of this subset of patients helps minimize the incidence of bleeding.

摘要

我们的研究旨在从先前收集的一组华法林剂量稳定且国际标准化比值能达到2至3的患者队列(n = 4272)中,确定诸如人口统计学、临床和基因数据等华法林敏感性的预测因素。采用两阶段方法确定华法林敏感性(剂量≤21毫克/周)的预测因素。首先,进行双变量分析,连续变量采用方差分析,分类变量采用χ检验,以确定华法林敏感性的可能预测因素(P < 0.05)。其次,使用双变量分析步骤中确定的预测因素进行向后逐步选择的逻辑回归,以生成包含P < 0.05的独立预测因素的最终模型。华法林敏感性增加与年龄增加、CYP2C9基因型2/3、1/3和3/3、VKORC1基因型AA和AG以及使用胺碘酮有关。华法林敏感性降低(即每周华法林剂量>21毫克)与身高增加、体重增加、患有糖尿病、VKORC1基因型GG和CYP2C9基因型1/1有关。总之,我们确定了与华法林敏感性相关的患者特征。该项目有望通过在服用华法林前识别出需要低剂量华法林的患者来改善患者护理。早期识别这部分患者有助于将出血发生率降至最低。

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