Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA.
Department of Pharmacy, Mayo Clinic Hospital, 200 1st St SW, Rochester, MN, 55905, USA.
Am J Cardiovasc Drugs. 2018 Jun;18(3):223-229. doi: 10.1007/s40256-017-0261-0.
Anticoagulation with warfarin affects approximately 140,000 post-cardiac surgery patients every year, yet there remains limited published data in this patient population. Dosing remains highly variable due to intrinsic risk factors that plague cardiac surgery candidates and a lack of diverse literature that can be applied to those who have undergone a cardiac surgery alternative to heart valve replacement (HVR). In the present study, our aim was to compare the warfarin requirements between HVR and non-HVR patients.
This was a single-center, retrospective study of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester, from January 1st, 2013 to October 31st, 2016. The primary outcome was the maintenance warfarin dose at the earliest of discharge or warfarin day 10 between patients with HVR and non-HVR cardiac surgeries.
A total of 683 patients were assessed during the study period: 408 in the HVR group and 275 in the non-HVR group. The mean warfarin maintenance doses in the HVR and non-HVR groups were 2.55 mg [standard deviation (SD) 1.52] and 2.43 mg (SD 1.21), respectively (adjusted p = 0.65). A multivariable analysis was performed to adjust for gender, age, body mass index and drug interactions.
This was the largest study to evaluate warfarin dose requirements in post-cardiac surgery patients and is the first to compare warfarin requirements between HVR and non-HVR patients during the immediate post-operative period. Both groups had similar warfarin requirements, which supports expanding the initial warfarin dosing recommendations of the 9th edition Chest guideline to include non-HVR patients as well as HVR patients.
每年约有 14 万名心脏手术后患者需要接受华法林抗凝治疗，但目前针对这一患者群体的相关研究数据仍然十分有限。由于心脏手术候选人群存在固有风险因素，且缺乏可应用于心脏手术替代心脏瓣膜置换术（HVR）患者的多样化文献，因此华法林的剂量仍存在较大差异。本研究旨在比较 HVR 与非 HVR 患者的华法林需求。
这是一项单中心回顾性研究，纳入了 2013 年 1 月 1 日至 2016 年 10 月 31 日期间在梅奥诊所罗切斯特院区接受心脏手术后开始服用华法林的患者。主要结局为 HVR 与非 HVR 心脏手术患者中，最早在出院时或华法林治疗第 10 天的维持华法林剂量。
研究期间共评估了 683 例患者：HVR 组 408 例，非 HVR 组 275 例。HVR 组和非 HVR 组的华法林维持剂量分别为 2.55mg（标准差[SD] 1.52）和 2.43mg（SD 1.21）（调整后 p=0.65）。进行了多变量分析以调整性别、年龄、体重指数和药物相互作用的影响。
这是评估心脏手术后患者华法林剂量需求的最大型研究，也是首个比较心脏手术后即刻 HVR 与非 HVR 患者华法林需求的研究。两组患者的华法林需求相似，这支持将第 9 版《胸部指南》的初始华法林给药建议扩展至非 HVR 患者以及 HVR 患者。
