Hohlfelder Benjamin, Sylvester Katelyn W, Rimsans Jessica, DeiCicchi David, Connors Jean M
Department of Pharmacy Services, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA.
J Thromb Thrombolysis. 2017 May;43(4):498-504. doi: 10.1007/s11239-016-1468-7.
Bivalirudin may cause a falsely prolonged international normalized ratio (INR) that complicates the discontinuation of bivalirudin when used as a bridge to warfarin. To prospectively validate our novel bivalirudin to warfarin transition nomogram, adult patients who received bivalirudin as a bridge to warfarin between July 2015 and June 2016 were prospectively evaluated, utilizing our predictive nomogram. The major outcome of our analysis was the correlation between the predicted change in INR upon bivalirudin discontinuation based on the nomogram, and the actual change in INR upon bivalirudin discontinuation. The major outcome was analyzed using the Pearson's correlation test. A Pearson's correlation coefficient >0.6 was considered to be a strong correlation. Bivalirudin was used as a bridge to warfarin in 29 patients. The majority of patients (86%) included in the analysis had a ventricular assist device. The median initial bivalirudin rate was 0.07 mg/kg/h and the mean increase in INR when starting bivalirudin was 0.6. The mean final weight-based bivalirudin rate was 0.08 mg/kg/h and the mean change in INR after stopping bivalirudin was 0.7. The Pearson correlation coefficient between the predicted change in INR upon bivalirudin discontinuation and the actual change in INR upon bivalirudin discontinuation was 0.86 (p < 0.001). After bivalirudin discontinuation, 68% of patients had a therapeutic INR. The results of this prospective analysis successfully validated our novel bivalirudin to warfarin transition nomogram. There was a very strong correlation between the predicted change and actual change in INR upon bivalirudin discontinuation.
比伐卢定可能会导致国际标准化比值（INR）假性延长，这在比伐卢定作为华法林的过渡用药时，会使比伐卢定的停药过程变得复杂。为了前瞻性地验证我们新的比伐卢定转换为华法林的列线图，我们对2015年7月至2016年6月期间接受比伐卢定作为华法林过渡用药的成年患者进行了前瞻性评估，使用我们的预测列线图。我们分析的主要结果是根据列线图预测的比伐卢定停药后INR的变化与比伐卢定停药后INR的实际变化之间的相关性。主要结果采用Pearson相关检验进行分析。Pearson相关系数>0.6被认为具有强相关性。29例患者使用比伐卢定作为华法林的过渡用药。分析纳入的大多数患者（86%）使用了心室辅助装置。比伐卢定的初始中位剂量率为0.07mg/kg/h，开始使用比伐卢定时INR的平均增加值为0.6。基于体重的比伐卢定最终平均剂量率为0.08mg/kg/h，停用比伐卢定后INR的平均变化为0.7。比伐卢定停药时预测的INR变化与比伐卢定停药时INR的实际变化之间的Pearson相关系数为0.86（p<0.001）。停用比伐卢定后，68%的患者INR处于治疗范围内。这项前瞻性分析的结果成功验证了我们新的比伐卢定转换为华法林的列线图。比伐卢定停药时预测的INR变化与实际变化之间存在非常强的相关性。
