Hou Huixiang, Yue Aihua, Hao Xu, Yang Li, Xue Yingying
Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, P.R. China.
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, P.R. China.
Exp Ther Med. 2024 Dec 30;29(2):40. doi: 10.3892/etm.2024.12790. eCollection 2025 Feb.
Warfarin is a commonly employed anticoagulant drug aimed at rapidly reaching the optimal international normalized ratio (INR), potentially reducing the hospitalization time in clinical settings. However, limited research has been conducted on the influencing factors and the safety implications of promptly reaching the target INR range in patients with valvular heart disease who have undergone valve replacement or repair. The present study aimed to assess the factors related to the safety considerations of rapidly reaching the target INR range in patients treated with warfarin. A retrospective cohort investigation was performed on hospitalized patients treated with warfarin between July 2022 and June 2023. Patient data were gathered from patient documentation. A total of 175 patients were included in the current study. The mean time to reach an effective INR threshold was 9.8 days (median, 3-28 days). Age >65 years, body mass index <24 kg/m, no smoking history and warfarin starting dose ≥3 mg/day were separate factors linked to rapidly reaching the effective INR threshold for warfarin management. The occurrence of INR levels ≥4 was significantly elevated among patients who reached the effective INR threshold more rapidly, while bleeding incidents were not significantly different. Inpatients aged >65 years, those with a body mass index <24 kg/m², no smoking history or prescribed a starting warfarin dosage ≥3 mg/day had a higher likelihood of rapidly reaching the effective INR threshold with warfarin. To enhance safety for these patients, enhanced INR tracking and suitable warfarin dosage adjustments are suggested following the initiation of oral warfarin therapy.
华法林是一种常用的抗凝药物，旨在迅速达到最佳国际标准化比值（INR），可能会缩短临床环境中的住院时间。然而，对于接受瓣膜置换或修复的瓣膜性心脏病患者迅速达到目标INR范围的影响因素及安全性影响，相关研究较少。本研究旨在评估使用华法林治疗的患者迅速达到目标INR范围的安全性相关因素。对2022年7月至2023年6月期间住院接受华法林治疗的患者进行了回顾性队列研究。患者数据从患者病历中收集。本研究共纳入175例患者。达到有效INR阈值的平均时间为9.8天（中位数为3 - 28天）。年龄>65岁、体重指数<24 kg/m²、无吸烟史以及华法林起始剂量≥3 mg/天是与华法林治疗迅速达到有效INR阈值相关的独立因素。在迅速达到有效INR阈值的患者中，INR水平≥4的发生率显著升高，而出血事件无显著差异。年龄>65岁的住院患者、体重指数<24 kg/m²的患者、无吸烟史的患者或起始华法林剂量≥3 mg/天的患者，使用华法林迅速达到有效INR阈值的可能性更高。为提高这些患者的安全性，建议在开始口服华法林治疗后加强INR监测并进行适当的华法林剂量调整。
